The PSA Controversy and the New York Times

The New York Times, like all news media, is a vehicle to air conflicting views. The November 25, 2014 issue ran a strongly-worded editorial opinion piece by Richard Ablin, PhD, the self-proclaimed “discoverer of PSA.” (As a biomarker that could be introduced into clinical detection, the honor goes to T. Ming Chu. But that’s another discussion.) You probably know about the U.S. Preventive Services Task Force recommendation against broad screening for men with no know risk factors for prostate cancer, a decision well in advance of the more recent European study that Ablin criticizes in his piece.

Ablin makes several allegations about the investigational team behind the European Randomized Study of Screening for Prostate Cancer (ERSPC). The ERSPC found a 21% reduction in death from prostate cancer thanks to PSA screening, but concluded that the benefit did not outweigh the harmful impact of possibly unnecessary biopsies, and the urinary and sexual damage due to overtreating cancers that might well have been monitored or untreated. Thus, it advised against widespread screening. In case you think a 21% reduction is terrific, it’s a misleading number: the average middle-aged man has about a 3% chance of dying from prostate cancer if he is never screened, so the risk reduction means he would have a 2.4% chance of disease-related mortality.[i] From a statistical standpoint, this is negligible.

But that’s not what spurred Ablin to comment. Rather, he cited the authors for withholding their data from  independent requests to review it, possible selective use of data, biased patient treatment, unethical lack of informed consent, and financial conflict of interest.[ii]

Ablin’s published opinion offended the authors of the ERSPC. Their letter of retort appeared in the NY Times on December 12. After “strongly” rejecting Ablin’s allegations, and responding specifically to each, authors Jonas Hugosson and Fritz Schröder declared, “The results of the European Randomized Study do not justify large-scale P.S.A. screening because the balance of benefits and harms remains uncertain, and this has been the key message of our papers. Over diagnosis and over treatment are legitimate concerns, but cannot be blamed on our study, which has provided the evidence for judicious considerations of the pros and cons of prostate cancer screening for policy makers, medical professionals and men in general.”[iii]

While the NY Times is laudable for airing some of the contentiousness that surrounds the ERSPC, they rejected a letter from urologist John McHugh (Gainesville, GA) who then published it on his own blog.[iv] After pointing to the emotionally-charged tone of Ablin’s opinion piece, he identifies certain ironies between what Ablin wrote and statements on his Foundation’s website. More importantly, McHugh passionately argues for routine PSA screening for saving thousands of lives regardless of the side effects. He himself was diagnosed with prostate cancer as a result of the test.

An editor has a tough job. It must be hard – at times even excruciating – to choose one letter out of several due to space limitations. Still, in presenting more than one facet of a controversial topic, the Times and all news media help avoid leaping to snap judgments. In medicine, we are at a turning point in detecting prostate cancer as new biomarkers are developed, approved and brought to market. Someday the PSA test, in its current form, will go the way of the dinosaurs. In the meantime, it’s good to be aware of conflicting opinions, and we can only hope that they are respectfully expressed after those who issue them have done their due diligence to justify them.


 

[i] Parker-Pope, Tara. “Prostate cancer screening still not recommended for all.” New York Times, Aug. 6, 2014.

[ii] Ablin, Richard. “The problem with prostate screening.” New York Times, Nov. 25, 2014.

[iii] Hugosson, Jonas and Schröder. “Study of prostate screening: investigators respond.” Letter to the Editor, New York Times, Dec. 12, 2014.

[iv] https://theprostatedecision.wordpress.com/about/my-letter-to-the-new-york-times-in-regards-to-richard-albin-discoverer-of-psa/