{"id":466,"date":"2014-12-02T16:39:51","date_gmt":"2014-12-02T16:39:51","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=466"},"modified":"2017-08-21T12:06:28","modified_gmt":"2017-08-21T12:06:28","slug":"primary-care-corner-with-geoffrey-modest-md-psa-screening-shenanigans","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/12\/02\/primary-care-corner-with-geoffrey-modest-md-psa-screening-shenanigans\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: PSA screening shenanigans??"},"content":{"rendered":"<p><strong>By: Dr. Geoffrey Modest<\/strong><\/p>\n<p>There was an <a href=\"http:\/\/www.nytimes.com\/2014\/11\/26\/opinion\/the-problem-with-prostate-screening.html?ref=opinion&amp;_r=0\">editorial<\/a> 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 &#8220;The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster&#8221;). \u00a0There was also a recent <a href=\"http:\/\/www.medscape.com\/viewarticle\/828854_1\">interview<\/a> of him by Eric Topol.<\/p>\n<p><a href=\"http:\/\/www.medscape.com\/viewarticle\/828854_7\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-468\" src=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/files\/2014\/12\/Untitled1-300x187.png\" alt=\"Untitled\" width=\"342\" height=\"213\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<p>His basic comments:<\/p>\n<p style=\"padding-left: 30px\">&#8211;In reviewing the European Randomized Study of Screening for Prostate Cancer (ERSPC),\u00a0and 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\u00a0 ERSPC\u00a0was 29% reduction in those adherent to the study (see DOI: <strong>N Engl J Med 2012; 366:981-990<\/strong>)<\/p>\n<p style=\"padding-left: 30px\">&#8211;There were inherent concerns about about the methadology, including transferring 60% of the data from Goteberg to\u00a0the ERSPC, strongly tipping the balance of the 7-country study by this one country which showed such a dramatic positive result.<\/p>\n<p style=\"padding-left: 30px\">&#8211;There were significant conflicts of interest in the investigators, being involved in companies that market PSA tests or related technologies.<\/p>\n<p>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: <strong>N Engl J Med 2009; 360:1310-1319<\/strong>), 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&#8230;..<\/p>\n","protected":false},"excerpt":{"rendered":"<p>PSA screening shenanigans?? [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/12\/02\/primary-care-corner-with-geoffrey-modest-md-psa-screening-shenanigans\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":148,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[14283],"tags":[],"class_list":["post-466","post","type-post","status-publish","format-standard","hentry","category-archive"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/466","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/users\/148"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/comments?post=466"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/posts\/466\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/media?parent=466"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/categories?post=466"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/wp-json\/wp\/v2\/tags?post=466"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}