Australian Medical Journal

This article was highlighted by the very informative "The "New" Prostate Cancer InfoLink":

Med J Aust. 2010 Apr 5;192(7):393-6.

It's time to depolarise the unhelpful PSA-testing debate and put into practice lessons from the two major international screening trials.
Denham JW, Bender R, Paradice WE.

Prostate Cancer Trials Group, University of Newcastle, Newcastle, NSW, Australia. jim.denham@newcastle.edu.au.

Abstract
Two recently reported large-scale trials conducted in the United States and western Europe have provided evidence that coordinated screening programs will not reduce mortality in countries or regions where prostate-specific antigen (PSA) testing is already highly prevalent, but will reduce mortality in places where PSA testing prevalence is low. The trials also produce evidence that coordinated screening will cause over-diagnosis and over-treatment. The instigation of a national screening program should be delayed until a more specific marker for aggressive disease than PSA level becomes available. In the meantime, results of the two trials can be used to inform the development of regional testing policies in Australia. These policies should encourage regular PSA testing in regions with low testing prevalence, but must also embrace methods of dealing with over-diagnosis and over-treatment. "Active surveillance" programs (whereby men with early-stage cancers are monitored regularly by PSA testing and digital rectal examinations) and development of counselling services should be encouraged.

PMID: 20367587 [PubMed - in process]


It's time to depolarise the unhelpful PSA-testing debate and put into practice lessons from the two major international screening trials.


And from "The "New" Prostate Cancer InfoLink":

Some common sense about prostate cancer screening … from Australia
Posted on April 19, 2010 by Sitemaster

A new article in the Australian Medical Journal is titled, “It’s time to depolarise the unhelpful PSA-testing debate and put into practice lessons from the two major international screening trials.” We think this article makes a lot of sense.
After summarizing the key data from the PCLO trial and the ERPC trial published in the New England Journal of Medicine last year, Denham et al. make some forthright comments and suggestions. Obviously their comments are specific to the situation in Australia, but they also offer food for the rest of us to think about:

•The application of true national screening programs should be delayed until a more specific marker for aggressive prostate cancer is available.
•Data from the PCLO and ERPC trials can and should be used to “inform the development of regional testing policies.”
•Such “regional testing policies” should encourage the regular use of PSA testing in regions (and among population groups) where testing prevalence has historically been low, but must also embrace methods of dealing with the risks associated with over-diagnosis and over-treatment.
•“Active surveillance” programs (whereby men with early-stage and relatively low-risk cancers are monitored regularly by PSA testing and digital rectal examinations) and development of counseling services should be encouraged.

The “New” Prostate Cancer InfoLink strongly endorses this mindset. What the authors are saying is simple: “Don’t throw out the baby with the bathwater, but also don’t pretend that the problems defined by the two major screening trials (and which all knowledgeable clinicians and prostate cancer advocates are well aware of) don’t exist and have serious ramifications.”

Some common sense about prostate cancer screening … from Australia