Cancer expert calls for better test for prostate cancer

A leading US cancer control expert believes a better test is needed for prostate cancer screening to replace the controversial PSA (prostate specific antigen) test.

Dr Otis Brawley is the Chief Medical Officer of the American Cancer Society and Professor at Emory University. He is a critic of the over-reliance on PSA screening and the overtreatment of prostate cancer.

Dr Brawley was in Perth Wednesday 15 April to address the Behavioural Research in Cancer Control Conference, hosted by the Cancer Council Western Australia.

"We need a better test than the current PSA. It misses as many cancers as it finds and the biggest problem is that it cannot distinguish between aggressive and slow growing tumours," Dr Brawley said. "As a result some men are being treated for a cancer that may not be a threat to their life and that treatment can significantly impair quality of life."

"The only study to suggest that screening saves lives also shows us that for a man diagnosed with prostate cancer through PSA screening, the diagnosis is about 50 times more likely to ruin his life than it is to save his life."

There is no current national population-based screening program for prostate cancer in Australia and Dr Brawley said there shouldn’t be one until a better test is developed.

"Until a better test is developed, I am not opposed to prostate cancer screening but I do feel that men should be informed of the uncertainties regarding current screening technology, the proven risks and the fact that scientific proof of benefit is weak at best.

"Right now it has to be an individual decision made by a well informed man. Men need to fully understand the potential risks as well as the potential benefits of the test and then be allowed to make their own choice about whether to take the test," Dr Brawley said. "A man who is very concerned about prostate cancer can reasonably decide to get screened and a man who is less concerned can reasonably decide not to get screened.

"There is a big difference between what happens between a patient and doctor and mass screenings."

Last month the man who created the PSA test said its popularity had lead to a ‘hugely expensive public health disaster’.

Writing in the New York Times, Professor Richard Amblin, who discovered PSA in the 1970s, said the test was no more effective than a coin toss.

"Many supporters of prostate screening mislead people to believe that it is clearly only beneficial, when evidence at best shows it may save lives but also shows there are clear harms associated with screening," Dr Brawley said.

(Source: Cancer Council Western Australia: Behavioural Research in Cancer Control Conference, Perth: April 2010)