By: Dr. Geoffrey Modest
There was an editorial in the NY Times on 11/26/14 written by the pathologist who discovered PSA in 1970 (and writer of a book on it, called “The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster”). There was also a recent interview of him by Eric Topol.
His basic comments:
–In reviewing the European Randomized Study of Screening for Prostate Cancer (ERSPC), and the Swedish Goteberg study (which was the basis for the European one) and had a 44% reduction in prostate cancer deaths, they refused to allow outside investigators to review the data. The 11-year followup reported in NEJM from the whole ERSPC was 29% reduction in those adherent to the study (see DOI: N Engl J Med 2012; 366:981-990)
–There were inherent concerns about about the methadology, including transferring 60% of the data from Goteberg to the ERSPC, strongly tipping the balance of the 7-country study by this one country which showed such a dramatic positive result.
–There were significant conflicts of interest in the investigators, being involved in companies that market PSA tests or related technologies.
So, just muddies the water a bit more (and who would have thought they could be muddier). The US study, also reported in NEJM (see DOI: N Engl J Med 2009; 360:1310-1319), did not find benefit from screening, though had its own issues (much contamination of the groups). Ablin might also have his own issues: he discovered the PSA test, targeted it for use as a marker to follow known prostate cancer and not a screening test, may be promoting his book, etc. But it is certainly concerning if the most positive study (ERSPC) is potentially biased by a single Swedish study, and they will not release their data for review…..