psa great hoax

7/23/2019 PSA Great Hoax

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in 2012 US perventive services task forcerecommended against psa screening on the groundthat there is no net benefit and that the potential

harms outweight the benfitt.

AUA outraged at this decision, criticized aspremature in a rapidl evolving area of intensive

research

!he great prostate "oa#?

$r. %ddu.s.srinadh&'(S, )%*U, &.S,. &.(h,$+*

*adr al sama group of hospitgals&uscat

Sultanate of oman



SA or +o SA -

)orgive !hem for !he now /hat +ot !he $o



6 7 Y R S

A S I A NP S A D O N E A S A R O U T I N E S C R E E N I N G D U E T O A G E

N O F A M I L Y H / O P R O S T A T I C C A N C E R

O N E N Q U R Y A D M I T T E D O F H A V I N G L U T S

I P S S S C O R E : 6

U R O F L O W M E T R Y ; Q . M A X : 6 M L / S C

D R E : N O R M A L

U S S ; N O R M A L

P S A : 8 . ! 8 . " ! 6 . # . ! 6 . 8 . ! 8 .

M R I : L T L T E R A L S M A L L C O C I A P I C A L L E S I O N $ C M

C Y S T O S C O P Y : S H O W E D M E D I A N L O % E E N L A R G E M E N T

U S S G U I D E D % I O P S Y : A T Y P I C A L S M A L L A C I N A R P R O F I F E R A T I O N

(ase no1



(ase no 2n enuir

345m Arab6ncidentall found increased psa+o 7U!S$'%8 normal

sa84.9. 9.:, :.0



/ent to india

Underwent &'6

&'6 showed multiple nodulalr lesions in the tranasitional zone ,

+o evidence of malignanc



% I O P S Y M O S T O F T H E C O R E S A R E % E N I G N

E X C E P T O N E C O R E S H O W E I N G A S A P

Underwent ultrasound guided

biops



sa8:,1:,;

<.4<.::.1



'ichard =. Ablin h.$. first observed the antigen SA fort earsago. !. &ing (hu of the 'oswell ark (ancer 6nstitute developed

the process to test for it. Urologists (ooner and Scardino did theclinical studies that resulted in the recommendation thatscreening,

6 then happened upon the 'obert *. Ablin )oundation for (ancer'esearch.

!he )oundation is dedicated to Ablin>s father 'obert who died ofprostate cancer. n the surface it all fits together uite nicel? thediscoverer of S



SA

'ichard @ Albin6mmunologist*ufallo

1490(rosurger for carcinoma of prostate

!. &ing chu biochemist from bufallo

!he American Association for (ancer 'esearch cited SA as one of the7andmark Scientific $iscoveries of the

20th (entur



"britech

Sandiago

(ommercialized

1443 8)$A approved

Strongl propagated b

/illliam catalona



W&''&() *(+(',-(



opulation or mass screening is defined as thesstematic e#amination of asmptomatic men Bat

risk C.

%ver ear ; billion dollars spent on psa screening

*ut things changed

eople started uestining its value



O- )(- &- &0 1&'' 2 3&(4-,3 1&+5,+(+ *(-* 3&-4 5& '&9+&)! 2+ ,-',- )(- &- " 1&'' 3& 9,) &+.



/h did he do so

!he discover of the psa himself turned againistitBcreator became the destroerC

According to him

SA is not cancer specific+o natural cut off point

6t can not defferentiate latent cancer , non clinicalcancer and aggressive cancer

(a prostate is a age related cancer, if ou do biopsin aged populationB<0D90 rsC <0 E of them willhave ca. prostate



/hat he sas

SA screening is a public health disaster

Use of SA testing for screening of prostatic cancer

in asmptomatic men was strictl for mone and alots of mone.

6t is a wish to defect cancer at an cost and imperfect

understanding of how psa works



rostatic cancer is a age relateld cancer

%#?if ou do biops between <0D90 rs age groupabout <FE of them had cancer



S*-&-4 (-3 P,+(+ C(-* M,+('&+: R'+ ,9 +5 E,(- R(-3,)&3 S+3,9 S*-&-4 9, P,+(+ C(-* <ERSPC= (+ " Y( ,9 F,'',1>U<L(-*+ (4! @=

6n this update the %'S( confirms a substantialreduction in prostate cancer mortalit attributable to

testing of SA, with a substantiall increasedabsolute effect at 1; ears compared with findingsafter 4 and 11 ears. $espite our findings, furtheruantification of harms and their reduction are still

considered a prereuisite for the introduction ofpopulatedDbased screening.



G6magination is more important than knowledge. )orknowledge is limited to all we now know andunderstand, while imagination embraces the entire

world, and all there ever will be to know andunderstand.

H Albert %instein

http://www.goodreads.com/author/show/9810.Albert_Einstein

http://www.goodreads.com/author/show/9810.Albert_Einstein



18 F, )- (43 @B6#! &3-* 3),-+(+ +5(+ PSA ++&-4 3*

,+(+ *(-*>*&9&* ),+('&+ (-3 +5 &-*&3-* ,9 )+(+(+&* ,+(+

28 P,+(+ *(-* 3&(4-,& )+ 2 -*,'3 9,) ,+(+ *(-*

&-+-+&,-.

". PSA ++&-4 5,'3 -,+ 2 *,-&33 ,- &+ ,1-! 2+ (+5 ( (+ ,9 ()'+&(&(2' (,(*5 +, (' ,+(+ *(-* 3+*+&,-.

. O'3 )- &- 4,,3 5('+5 1&+5 +- ( '&9 0*+(-* 5,'3 -,+ 2

3-&3 PSA ++&-4 ,- +5 2(& ,9 +5& (4.

F. %('&- PSA ++&-4 9, )- &- +5& @ & 9' 9, 3&*+&-4 +59+ & ,9 ,+(+ *(-*.



Iuideline of guidelines ?psa screeningJ*=U6 october 2013

T5 U-&+3 S+(+ P-+& S&* T( F,* <USPSTF=!he USS!) is a group of health e#perts that makes recommendations

about preventive healthcare

. 6n 200:, this group recommended against SA screening for men agedK9F ears

6n 2012, the USS!) updated their literature review and instead issued aIrade $ recommendation against prostate cancer screening for men of allages L

!he rationale that the gave for this8

is that for ever 1000 men screened, there would be onl one fewer

prostate cancer death

but ;0M30 men with incontinence or erectile dsfunction due totreatment, two with serious cardiovascular events, and one with venousthrombosis.



G&3'&- ,9

4&3'&-

'andomised trials have shown thatSA screening reduces metastatic

prostate cancer and diseaseDrelateddeath.

!he USS!) recommends against SAscreening, while most other

professional organisations recommendshared decisionDmaking about SAscreening.

SA screening should be discontinuedfor men with N10Dear life e#pectanc.

Several guidelines now recommend baseline SA testing for men in hteir30s for risk stratification

psa great hoax

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