RACGP under fire over prostate screening
VIDEO Dr Ginni Mansberg interviews both uro-oncologist Professor Declan Murphy and Professor Chris Del Mar of the RACGP about the current debate over PSA testing...
THE RACGP stands accused of scaremongering as doctors continue to trade salvos over the recent bid by pathologists to enter the debate on PSA testing.
Uro-oncologist Associate Professor Declan Murphy last week condemned “emotive language” used by the RACGP in defending its stand against prostate cancer screening of asymptomatic men.
RACGP spokesman Professor Chris Del Mar had warned that a statement by the Royal College of Pathologists of Australasia (RCPA) may send a signal to patients that screening was beneficial, when in fact it may do more harm than good.
“That’s scaremongering,” said Professor Murphy, a consultant urologist and director of robotic surgery at the Peter MacCallum Cancer Centre, Melbourne.
While debate was healthy, he said he was concerned about the “really quite strong message” against PSA testing.
“They’ve said there’s no convincing evidence that prostate cancer screening saves lives,” he said. “And the problem with that particular statement... is unfortunately there’s lots of evidence that... testing does save lives when you compare a group of men who get PSA tested and those who don’t.”
GPs who issued advice to the contrary may be putting themselves at risk, he said.
A recent prostate cancer conference heard of two cases of patients with prostate cancer suing GPs over the issue of ordering PSA tests, he said.
Professor Murphy cited a 2010 Swedish study published in Lancet Oncology showing a 44% reduction in prostate cancer mortality at a 14-year follow-up.
“We don’t want to go back to those dark days when, in 1990, 20% of patients were turning up with metastases with prostate cancer, as opposed to the current figure of about 4%,” he said.
The latest controversy was sparked when Professor Del Mar questioned an RCPA statement recommending men who want to assess their prostate cancer risk be offered a PSA test and a digital rectal examination from age 40 as a baseline measure of risk.
Professor Del Mar last week reiterated the RACGP was concerned about overdiagnosis stemming from PSA testing, and said he rejected the accusation the college was scaremongering.
“The scaremongering, actually, is coming from bodies such as the Urological Society and the pathologists … implying PSA screening is going to be helpful… while no public health bodies are advocating it, not in any country. So I stand by that one,” he said.
He said the RACGP was not proposing that men be denied PSA tests but the issue could be discussed with patients if they asked about the tests.
The Swedish study was a sub-group analysis of data from one centre involved in a trial showing a small difference in mortality after 14 years, but “one swallow doth not a summer make”, he said.
“I don’t think we should bring up the subject [of PSA testing] any more than we should bring up the subject of screening for lung cancer, which we don’t yet think is a worthwhile proposition.”