October 2017 April 2015 | Page 11

Te Puawai

Prostate Screening
Reprinted with the kind permission of the Auckland Women’s Health Council Newsletter

A recent opinion piece in the New York Times
by Richard Ablin, the man who discovered the
prostate-specific antigen, or PSA, is
surprisingly entitled “The Problem with
Prostate Screening.” (1)
The PSA test is now the most widely used tool
in prostate screening and Professor Ablin is
concerned at how it is being used. “There has
been a growing concern about whether the
use of the PSA test has led to over-diagnosis
and
overtreatment,
with
millions
of
unnecessary surgeries, complications and
deaths,” he writes.
His concerns are centred around the recent
publication of the results of two studies which
reported large reductions in prostate cancer
deaths. One is the European Randomized
Study of Screening for Prostate Cancer, and
the other is the Swedish Goteborg study, the
results of which provided a basis for the
European Randomized Study.
Unfortunately there are big problems with both
of these studies. Major concerns about the
methodology and results of the studies were
first raised earlier this year in the Journal of
the National Cancer Institute by two Australian
researchers. In March the Goteborg study’s
authors announced in the British Medical
Journal that their data “are not available to
outside investigators.”
“That the researchers would block access to
government- and charity-supported research
is bad enough. Even worse, it calls into
question why, if the data was strong, the
researchers wouldn’t open it up to

© Te Puawai

independent scrutiny,” Professor Ablin says.
The public must be able to trust that scientific
data from clinical trials is accurate and
unbiased, and he is worried “that this trust,
particularly when it comes to American men
and their physicians and screening programs
for prostate cancer, is now at risk.”
The issues that prompted his opinion piece
are unfortunately very familiar as the
preceding report on the Cochrane symposium
demonstrates. At their core is the impact of
conflicts of interest on research and how it is
reported, and these studies provide a
fascinating case study.
The European Randomized Study reported
results from seven countries, while Goteborg
was a single-site study in Sweden. In both,
men were divided into two groups: one group
underwent regular PSA tests, while the other
group was not screened. The results were
published in The New England Journal of
Medicine and the Lancet Oncology Journal
respectively.
The Australian researchers noticed that there
was something strange about the data sets –
a large amount of the data in the European
Randomized Study came from a separately
reported Finnish study which showed no
significant lifesaving benefits of PSA
screening.
There were also issues around biased patient
treatment. Many of the men who developed
prostate cancer received excessive amounts
of a treatment called hormonal mono-therapy
which has been found to accelerate cancer.

College of Nurses Aotearoa (NZ) Inc
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