More bad advice from the mainstream

My timing was perfect.

In last Thursday’s e-Alert, “Screen Pattern” (7/24/03), I told you why men and their doctors should NOT be quick to proceed with a prostate cancer biopsy based on a single prostate-specific antigen (PSA) screening. A new study shows that fluctuation in PSA levels are responsible for many unnecessary biopsies – painful procedures with unpleasant side effects.

That very same day, the New England Journal of Medicine (NEJM) released a study concluding that PSA screening misses too many cancers. The researchers’ recommendation: Lower the acceptable PSA level from 4.0 to 2.6. In other words: Let the biopsies roll!

This is the worst kind of mainstream thinking. With blinders firmly in place, the only reasonable solution these researchers could come up with – in response to a clearly insufficient test – was to sharply INCREASE the number of biopsies. With misguided logic like this, next they’ll be saying men should forget about the test altogether and just have a yearly biopsy!

Oh come on! It only hurts for a month!

Fortunately, cooler heads prevailed. In an accompanying NEJM editorial, the authors expressed reservations about the simplistic advice, stating that the recommendation should not yet be accepted as “routine clinical practice.” This point was also stressed by doctors on various news programs.

You have to wonder though; in spite of the call to show restraint, will this study just encourage those doctors who already have a “slash and burn” mentality about prostate biopsies? It very well could.

Late Thursday night on my local news, the anchor tucked the PSA study into a 20-second feature toward the end of the broadcast. After calling PSA screening “the gold standard” of prostate cancer testing, he simplified the matter by saying that doctors now recommend that more men receive prostate cancer biopsies.

He was doing his job; cutting the story down to its essential details. But I wonder if he has any idea what damage that sort of sloppy reporting can do when men take the bad advice at face value.

To Your Good Health,

Jenny Thompson
Health Sciences Institute

“Effect of Verification Bias on Screening for Prostate Cancer by Measurement of Prostate-Specific Antigen” New England Journal of Medicine, 349:335-342, No. 4, 7/24/03,
“Verification Bias and the Prostate-Specific Antigen Test – Is There a Case for a Lower Threshold for Biopsy?” Fritz H. Schroder, M.D., Ph.D., and Ries Kranse, Ph.D., New England Journal of Medicine, 349:393-395, No. 4, 7/24/03,
Prostate Test May Miss Many Tumors” Reuters, 7/23/03,