Samir Kleif’s column regarding prostate-specific antigen-based testing for prostate cancer (“Know benefits, risks, of prostate cancer testing,” Sept. 9) is disastrously inaccurate.
He states that the U.S. Preventive Services Task Force provided evidence-based recommendations against the PSA test, concluding that the potential benefit does not outweigh the expected harms. Unfortunately, he disregards the fact that the USPSTF relied on the profoundly flawed Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial study – more than 50 percent of the control group received screening during the study!
The largest screening study, the European Randomized Study of Screening for Prostate Cancer, demonstrated a 38 percent survival advantage in screened patients followed more than 10 years, and a recent study published in the American Cancer Society journal Cancer showed that without PSA screening, the incidence of advanced (thereby incurable) prostate cancer would have been 300 percent higher than actually observed.
Both the USPSTF and Dr. Khleif ignored reams of epidemiological data from this country. In the past 20 years, death rates from prostate cancer have declined 44 percent, although the overall incidence of cancer has been stable.
Before screening, 25 percent of men who were diagnosed with prostate cancer already had advanced, inescapably fatal, disease. With screening, that number has dropped by 75 percent. In the PSA screening era, 10-year survival is more than 98 percent, up from 53 percent before widespread screening. More prostate cancers are not being detected. We are detecting cancer earlier, and saving lives.
Dr. Khleif states that screening may cause pain, health problems, anxiety and worry. He confuses risks of screening (which are negligible) with treatment. But screening is not treatment; it is not even diagnosis. To deny men the right to basic information that they can then use to make their own health-care decisions is reprehensible.
This recommendation by the USPSTF was so egregious that something rarer than a hole-in-one at the Masters Tournament happened – bipartisan legislation was introduced by Republican U.S. Rep. Marsha Blackburn of Tennessee and Democratic U.S. Rep. John Barrow of Georgia, calling for significant changes to the USPSTF and the process by which the group makes formal recommendations regarding preventive-care services.
The column left out the most lethal fact about prostate cancer: When symptoms appear, there is no cure.
W. Price Dunaway
(The writer is chief operating officer of the multi-specialty physicians group Integrated Medical Professionals.)