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- Page navigation anchor for Prostate specific antigen testing and opportunistic prostate cancer screeningProstate specific antigen testing and opportunistic prostate cancer screening
Clift et al1 aimed to estimate PSA contamination in the control arm of the CAP prostate cancer screening trial, concluding that there is " limited plausibility of deriving clear conclusions from trials of PSA screening". However, their conclusion failed to acknowledge that the CAP intervention significantly increased prostate cancer detection: during the first 18 months following recruitment (the screening phase) there was a 5-fold increase in rate of prostate cancer detection: 10.42 per 1000 person-years in the intervention group vs 2.18 per 1000 person-years in the control group (P < 0.001).2 Such a difference would be expected to lead to mortality benefits over long-term follow-up, but there was little evidence of any subsequent mortality reduction from earlier detection. Relying on how urinary symptoms are coded may overestimate opportunistic PSA screening. In our analysis of 558 UK general practices,3 28% of men received a PSA test, but a raised PSA (≥3 ng/ml) was rarely followed with a prostate biopsy (6% of tests) or prostate cancer diagnosis (15%), as would be clinically expected for screening. In our trial, the corresponding figures were 85% undergoing biopsies and 34% diagnosed with prostate cancer. The CAP trial excluded London, the South East and West Midlands. In the Clift et al paper, 21% of men were from London and PSA screening was 34% hi...
Competing Interests: None declared. - Page navigation anchor for Prostate specific antifen testing and opportunistic prostate cancer screeningProstate specific antifen testing and opportunistic prostate cancer screening
This is a comprehensive and well-researched project on the uptake and access of prostate cancer screening. The authors correctly characterise the transition into a ‘post-trial world’ as the trend of prostate screening research is moving away from PSA testing. For an up-to-date overview of the issues surrounding prostate cancer screening I direct readers to the urology news summary article published last year.1 Most promising is the prospect of an MRI ‘prostatogram’ made feasible due to recent advances in speed of MRI scanning. Multiple trials are ongoing, including a Canadian randomised controlled trial comparing MRI and PSA screening. However, at time of writing the PSA test remains the primary screening modality for prostate cancer available to GPs.
For me, an aspect of PSA screening that still raises confusion clinicians and patients is what constitutes informed consent. As mentioned in the article, current NICE guidance suggests men may opt-in to screening through shared decision making with their GP. The authors defined opportunistic PSA testing as testing performed on individuals without urinary symptoms. I am curious about the author’s views on how to communicate information on opportunistic PSA testing to men in the primary care setting. There is mention in the article that the status quo is informal, testing based on clinical suspicion and risk factors. However, as the shown by the data, PSA testing upta...
Competing Interests: None declared.