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Gold, incentives and meh

Prostate cancer straight talking

I tell my patients:

·The PSA test is a poor screening test (but does have value as a useful tool to assess the progress of a known case of Ca prostate who has had all the work-up done).

·A value of 0-4 is properly normal or could mean your Ca prostate is so anaplastic as to make no antigen; you are either well or you are stuffed; you may even ignore valid symptoms on the basis of a low result.

·A value of 4-10 is inconclusive and our local laboratory suggests you go to the urology unit for tests. These tests will be up to 98 per cent unnecessary and cause a greater burden of disease on the population than not testing. They also occupy so much urological time as to adversely affect the treatment times of those patients who do have Ca prostate.

·A value of over 10 either means you have Ca prostate or have recently had intercourse or have defecated or had a rectal examination (recreational or professional).

·Values of over 4 will properly lead to a trans-rectal biopsy which is unpleasant and is looking for a needle in a haystack (more accurately a full stop in a chestnut) and therefore may give false reassurance.

·Most diagnosed cases are only watched anyway.

·Active treatment of Ca prostate does not extend life in the vast majority of clinical scenarios.

·You can still have the test as it is currently advised by a confused profession and an ignorant Government, and if I refuse 200 men I will have refused one with Ca prostate. Economically sound as that may be, no one would support me in that stance.

As Dr David Jewell said of the National Screening Committee's decision to support PSA: 'They came up with the advice to keep everybody quiet.'

Is that not the modus operandi by which patients get unnecessary antibiotics, etc? By whom are we led? What price evidence-based decisions?

Dr AW Taylor

Grasscroft, Oldham

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