New Analysis Confirms Suspected Bias of Large U.S. Prostate Screening Study

By David Sampson

A new paper appearing in Annals of Internal Medicine used simulation modeling to try to correct for a known bias in a notable U.S. trial of prostate cancer screening, called PLCO. That study along with a large European one played an important role in the creation of screening guidelines from the American Cancer Society and others.

While the major European trial, called ERSPC, suggested routine PSA screening reduced the risk of prostate cancer death by about 30 percent in men who were very compliant with screening and treatment, the U.S. study failed to show a benefit. The U.S. trial is widely-believed to have been contaminated; many men in the control arm, who were assumed to be unscreened, were in fact screened thanks to the wide availability of PSA testing at the time, diminishing the differences between the studies two arms.

We asked Chief Medical Officer Otis W. Brawley, M.D. if the new data changes the current understanding of PSA screening.

“This new analysis supports the widespread understanding that PSA screening under optimal conditions has larger mortality benefits than were shown by a large U.S. trial. It also supports a move towards watchful waiting that all experts hope will make screening as useful as possible.

“The new analysis uses a measure known as ‘mean lead time’ to try to account for suspected biases in the U.S.-based PLCO trial. Some consider this modeling controversial and unproven. Nonetheless, it may be useful in this situation.

“The findings from the new analysis are consistent with the assessments of most experts, who generally agree that prostate cancer screening is associated with a reduction in prostate cancer deaths, and that the U.S. trial undercounted this benefit.

“Screening recommendations from the American Cancer Society and others have acknowledged the limitation of the U.S. trial, so this new …read more

Source:: American Cancer Society