The strong impression one gets from reading the article by Pierre I. Karakiewicz and Armen G. Aprikian in the CMAJ prostate cancer series [1] is that serum prostate-specific antigen (PSA) screening in beneficial. Their initial teaching point reads "Early detection of prostate cancer is of utmost importance, given that localized disease represents the only curable stage." Does the evidence support this view, or is it a manifestation of wishful thinking? On the basis of the authors' own words, I would submit it is the latter. Karakiewicz and Aprikian admit that there is no direct evidence that treatment of prostate cancer is effective, but they also state that "definitive studies to prove that early detection and treatment lower the mortality rate have been initiated" (emphasis mine). Surely the studies referred to were designed to determine whether or not early detection and treatment lower mortality.
At present no one knows whether PSA screening for prostate cancer is beneficial. This should have been the initial teaching point in the article.
Kenneth G. Marshall, MD
London, Ont.
References
- 1.↵