A recent issue of the British Medical Journal (BMJ) – read widely by GPs – had an article about the outdated US PIVOT trial. Fortunately, Chris Booth – who is on our Clinical Advisory Board – saw it and responded as follows:
“Quoting from the USA’s PIVOT trial on Prostate Cancer (PCa) is another example of conclusions
being drawn from an outdated American study that is completely inelevant so far as current UK
urological practice is concerned. Worse still, it deflects GPs from giving balanced information to men
quite righly seeking PSA screening for PCa. Anyone wishing for an objective understanding of the
flaws in PIVOT should read D’Amico’s “Long-term Follow-up of PIVOT Argues for lmmediate
Treatmenl of Men With Unfavourable-Risk and Possibly High-Volume, Low-Risk Prostate cancer”.
“So far as UK practice is concerned, those seeking to give unbiased, objective, up-to-date
information on screening should note the substantial falls in PCa mortality – over 40% – achieved in
European screening programmes (eg Gothenburg and Rotterdam) compared with our dreadful annual
mortality of over 11,800 men. Furthermore, what does deserve publicity are the highly acclaimed UK
results from the PROMIS, PRECISION and ProtecT studies. These, together with the results of the
4th Nationat Prostate Cancer Audit, have demonstrated that the “harms” of PCa screening – “overdiagnosis and over-treatment” – have been largely overcome in current UK clinical practice.
The audit shows that there is a widening gap between our high mortality/poor screening statistics and
the excellent care now available to men lucky enough to have screen-detected, early, curable PCa. lt
also sadly confirms that over 50% of UK men still present with advanced and probably incurable PCa,
16% with metastases.
“The conclusion has to be that in the absence of better options, application of PSA screening
according to accepted national and international guidelines for properly informed men is the best way
we can lower our unacceptable death rate for this thoroughly unpleasant cancer.”
We are very grateful for Chris’ help.