Jane Brody, the New York Times doyenne of medical journalists, has recently penned two articles on the PSA test and Prostate Cancer Active Surveillance (AS). I use the term ‘doyenne’ with the greatest respect to our Advisory Board Member and AS Moderator, Howard Wolinsky, another fine medical writer, who ironically Brody prominently biographies in her second piece. Congrats to Mr. W !!
The two articles are:
- Debate the Value of PSA Prostate Screening, New York Times, Feb 24 2020
- Before Prostate Surgery Consider ‘Active Surveillance’, New York Times, March 2, 2020
The articles, while informative and generally helpful, lack perspective and accuracy. I would not go quite so far as to be grouped a bedfellow of “The Chumpster” and charge this widely read and esteemed daily with ‘Fake News’ ; but errors of inclusion and ommission are all the more significant given the prestige of the New York Times. Here are just a few suggested corrections:
- The PSA test is about information NOT treatment . At AnCan we strongly endorse widespread PSA testing because if you don’t know, you can’t treat. Overtreatment is down to poor communication between doctor and patient …..NOT the test.
- The quoted European PSA study was actually corrected post intial publication and its results endorse PSA testing.
- Epidemiological measures like the number of tests needed to save one life are infuriating to this pundit …… how do you value a life?
- There is no mention that prostate cancer specific deaths have actually risen in the past couple of years. Is it a coincidental correlation that this follows the USPSTF recommendations against testing by a suitably long enough time period to allow disease specific death? Both Howard (on MedPage Today) and I have written about this – see these Blog post.
- Dr. Eggener at my alma mater, the University of Chicago, is reported to have indicated about 5-10% of men choosing active surveillance progress and require treatment. In our view that number is grossly understated – Dr. Peter Carroll’s UCSF cohort reports it at much closer to one-third, and I believe that has been endorsed by other studies like the Canary Trial, and Dr. Klotz’ Sunnybrook cohort
- Gleason 7 disease, whether it be 3+4 or 4+3, is never low risk. Anytime you have a 4 in your Gleason score, you are at least intermediate risk, and your prostate cancer must be treated seriously ….. that does not mean certain men with 3+4 Gleasons cannot consider AS. They can, and there is extensive literature.
- Not all Gleason 6 disease should be reclassified IDLE , Dr. Eggener- it depends vey much on volume.
I could go on … but you get the idea! And it does not take away from the deserved kudos for our intrepid AS Warrior, Howard Wolinsky, who we recently welcomed as an additonal moderator to our Active Surveillance Prostate Cancer Virtual Group. That is becasue we are expanding the AS moderator team to accomodate a second meeting in response to the enthusiastically large atttendance for just one meeting a month! That, by the way, is this Wednesday, March 3 …. please join us.