Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials
Authors: Philip C. Prorok, Anthony B. Miller
Journal: Annals of Internal Medicine (2018)

Letters17 April 2018Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO TrialsPhilip C. Prorok, PhD and Anthony B. Miller, MDPhilip C. Prorok, PhDNational Cancer Institute, Bethesda, Maryland (P.C.P.)Search for more papers by this author and Anthony B. Miller, MDUniversity of Toronto, Toronto, Ontario, Canada (A.B.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0735 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:Tsodikov and colleagues' article (1) has a major flaw: The authors do not account for overdiagnosis caused by prostate-specific antigen (PSA) testing. They introduce mean lead time (MLT), a new and nonvalidated metric designed to encompass the process of early detection and diagnosis of cancer in different populations. Because some cases of cancer are detected by screening, MLT is confounded with the well-known screening biases, of which overdiagnosis is an important contributor. Without adjustment for overdiagnosis (a clear harm), MLT is a flawed metric for determining screening benefit and not a substitute for the definitive end point ...References1. Tsodikov A, Gulati R, Heijnsdijk EAM, Pinsky PF, Moss SM, Qiu S, et al. Reconciling the effects of screening on prostate cancer mortality in the ERSPC and PLCO trials. Ann Intern Med. 2017;167:449-55. [PMID: 28869989]. doi:10.7326/M16-2586 LinkGoogle Scholar2. Pinsky PF, Prorok PC, Yu K, Kramer BS, Black A, Gohagan JK, et al. Extended mortality results for prostate cancer screening in the PLCO trial with median follow-up of 15 years. Cancer. 2017;123:592-9. [PMID: 27911486] doi:10.1002/cncr.30474 CrossrefMedlineGoogle Scholar3. Miller AB. Prostate cancer screening. In: Miller AB, eds. Epidemiologic Studies in Cancer Prevention and Screening. Statistics for Biology and Health. Vol. 79. New York: Springer-Verlag; 2013:277-85. Google Scholar4. Moyer VA; U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157:120-34. [PMID: 22801674]. doi:10.7326/0003-4819-157-2-201207170-00459 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: National Cancer Institute, Bethesda, Maryland (P.C.P.)University of Toronto, Toronto, Ontario, Canada (A.B.M.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L17-0735. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoReconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials Alex Tsodikov , Roman Gulati , Eveline A.M. Heijnsdijk , Paul F. Pinsky , Sue M. Moss , Sheng Qiu , Tiago M. de Carvalho , Jonas Hugosson , Christine D. Berg , Anssi Auvinen , Gerald L. Andriole , Monique J. Roobol , E. David Crawford , Vera Nelen , Maciej Kwiatkowski , Marco Zappa , Marcos Luján , Arnauld Villers , Eric J. Feuer , Harry J. de Koning , Angela B. Mariotto , and Ruth Etzioni Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials Stuart G. Baker Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials Shinkan Tokudome , Ryosuke Ando , and Shuji Hashimoto Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials Alex Tsodikov , Roman Gulati , and Ruth Etzioni Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials Philippe Autier and Peter Boyle Reconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials Join Y. Luh , Steven E. Finkelstein , Jeff M. Michalski , and Howard Sandler MD Metrics 17 April 2018Volume 168, Issue 8Page: 605-606KeywordsCancer detection and diagnosisCancer screeningCancer treatmentConflicts of interestDisclosureLung and intrathoracic tumorsMortalityOvarian cancer screeningPopulation statisticsProstate cancer ePublished: 17 April 2018 Issue Published: 17 April 2018 PDF downloadLoading ...