Has PSA testing truly been a “public health disaster”?

Costello, Anthony J; Murphy, Declan G

doi:10.5694/j.1326-5377.2010.tb03729.x

PSA testing may lead to overtreatment, but this should not rule out its judicious use as an early predictor of prostate cancer

Two recent articles, an opinion piece from Richard Ablin, the discoverer of prostate-specific antigen (PSA) and a self-proclaimed “authority in the field”, published in the New York Times,1 and a subsequent interview with Ablin published in the BMJ,2 contend to inform the public of the “hugely expensive public health disaster” of PSA testing. Yes, PSA testing is not without its flaws, but to malign it in this manner is truly lamentable.

1 Australian Prostate Cancer Research Centre, Epworth Hospital, Melbourne, VIC.
2 Royal Melbourne Hospital, Melbourne, VIC.
3 Department of Urological Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC.

Correspondence: cosurol@bigpond.net.au

1. Ablin RJ. The great prostate mistake. New York Times 2010; 9 Mar. http://www.nytimes.com/2010/03/10/opinion/10Ablin.html (accessed Mar 2010).
2. Hawkes N. Prostate screening: is the tide turning against the test? BMJ 2010; 340: c1497.
3. Smith EM, Hampel N, Ruff RL, et al. Spinal cord compression secondary to prostate carcinoma: treatment and prognosis. J Urol 1993; 149: 330-333.
4. Walsh PC, DeWeese TL, Eisenberger MA. Localized prostate cancer. N Engl J Med 2007; 357: 2696-2705.
5. Lilja H, Ulmert D, Vickers AJ. Prostate-specific antigen and prostate cancer: prediction, detection and monitoring. Nat Rev Cancer 2008; 8: 268-278.
6. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med 2009; 360: 1320-1328.
7. Bastian PJ, Carter BH, Bjartell A, et al. Insignificant prostate cancer and active surveillance: from definition to clinical implications. Eur Urol 2009; 55: 1321-1330. Epub 2009 Mar 6.
8. Lilja H, Ulmert D, Bjork T, et al. Long-term prediction of prostate cancer up to 25 years before diagnosis of prostate cancer using prostate kallikreins measured at age 44 to 50 years. J Clin Oncol 2007; 25: 431-436.
9. Ulmert D, Cronin AM, Bjork T, et al. Prostate-specific antigen at or before age 50 as a predictor of advanced prostate cancer diagnosed up to 25 years later: a case–control study. BMC Med 2008; 6: 6.
10. Challacombe BJ, Murphy D, Lilja H, et al. The continuing role of prostate specific antigen as a marker for localised prostate cancer: “Do not throw the baby out with the bath water”. BJU Int 2009; 104: 1553-1554.

Online responses are no longer available. Please refer to our instructions for authors page for more information.