Why prostate test is being peddled

The Straits Times; Published on Oct 29, 2011
Why prostate test is being peddled
I WISH to draw attention to the following facts with reference to Singapore Urological Association president Dr Michael Wong Yuet Chen's letter yesterday ('Prostate cancer screening: Careful risk assessment vital').
First, the person credited with the discovery of prostate specific antigen (PSA), Professor Richard Ablin of the University of Arizona Medical School, has expressed remorse for his discovery.

He said recently that the current practice in the United States of administering the PSA test for the annual screening of prostate cancer in men of age 50 and older is a 'hugely expensive public health disaster'.
He said that the PSA testing cannot detect prostate and, more importantly, it cannot distinguish between the two types of prostate cancer - the one that will kill you and the one that will not.
Second, an editorial by Professor Michael J. Barry in the highly respected New England Journal of Medicine ('Screening for prostate cancer - the controversy that refuses to die'; March26, 2009) referred to two large randomised trials conducted in the US and Europe.
The US study reported no mortality benefit from combined screening with PSA testing and digital rectal examination during a median follow-up period of 11 years.
The European study reported that in order to save one prostate cancer death, 1,410 men would have to be screened and 48 men would have to undergo unnecessary surgery which could lead to incontinence and impotence.
The editorial concluded: 'Serial PSA screening has at best a modest effect on prostate cancer mortality during the first decade of follow-up.
'This benefit comes at the cost of substantial over-diagnosis and over-treatment'.
Prof Ablin said that PSA testing does have a place, after treatment for prostate cancer and for men with a family history of prostate cancer. There is, however, no case for general screening.
When asked why it is still being used, Prof Ablin replied: 'Because drug companies continue peddling the tests and advocacy groups push 'prostate cancer awareness' by encouraging men to get screened.'
Professor Tommy Koh
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