On 11 September at 8pm (GMT+1) #PHTwitJC will critique the following paper:
Vickers, A et al (2010) Prostate specific antigen concentration at age 60 and death or metastasis from prostate cancer: case-control study – published in the British Medical Journal and accessible on-line here.
Why is this paper relevant to public health?
Prostate cancer is the most common cancer in men in the UK; 37,000 men are diagnosed with prostate cancer every year (incidence) and 250,000 men are currently living with the disease (prevalence) according to The Prostate Cancer Charity.
Screening for prostate cancer is controversial because of cost and uncertain long-term benefits to patients. Prostate specific antigen (PSA) screening is widely used for the early detection of prostate cancer however there remains is a great deal of debate over the value of the PSA test as a screening test.
Summary of paper
A single measure of PSA at age 60 is associated with a man’s lifetime risk of death from prostate cancer. Most (90%) of deaths from prostate cancer occur in men in the top quarter of PSA concentrations (>2 ng/ml), though only a minority of such men will develop fatal prostate cancer. Men aged 60 with concentrations ≤1 ng/ml can be told that though theymight have cancer, it is unlikely to become life threatening. At least half of men at age 60 can be exempted from further screening. The paper suggests prostate cancer screening should instead focus on men with higher concentrations of PSA.
‘Live’ Public Health Twitter Journal Club will take place on Sunday 11th September, between 20:00 and 21:00 UK time (GMT+1). To follow and contribute to the discussion, remember to use the #PHTwitJC hashtag
The discussion points for this week are as follows:
- This paper uses a case-control study design – was this appropriate for this topic?
- Did recruitment for cases and controls affect selection bias?
- What confounding factors could be present? Have these been accounted for?
- Study concluded that “a single measure of PSA at age 60 is associated with a man’s lifetime risk of death from prostate cancer” – are these results valid?
- What are the PH implications of this study? How might these influence future practice/policy?
* CASP (Critical Appraisal Skills Programme) framework; 11 questions to help you make sense of a case control study, accessible via here
* UK National Screening Committee. Criteria for appraising the viability, effectiveness and appropriateness of a screening programme. 2009. Accessible here
* Health Knowledge Interactive Learning Module on Screening by Angela Raffle. Last accessed January 18, 2010. Accessible here