I am not sure what to do with this information, but it certainly could be described as a rather large elephant in the room. We all are very familiar with the prostate cancer PSA test controversy brought on by the United States Preventive Task Force (USPTF). To quickly review the issue, the USPTF developed a recommendation that the PSA test resulted in more harm than good when it was used for the screening of men for prostate cancer. Now we have just had a huge monkey wrench thrown into the equation!
The National Cancer Institute (NCI) recently announced that it had removed all prostate specific antigen (PSA) data from the SEER (Surveillance, Epidemiology and End Results) and SEER-Medicare programs. The SEER database is the major source of information for researchers, including the United States Preventive Task Force (USPTF) when they developed their recommendation about the PSA test.
Many of us knowledgeable individuals have held a strongly disagreed with this conclusion. We believe that the data used by the USPTF was flawed and so was their conclusion.
Despite this flaw, the effect of the USPTF opinion has rippled through the community and will mean that we will revert back to the bad old days when men will only be diagnosed with prostate cancer once it becomes advanced prostate cancer, thus being incurable. There is already beginning to be evidence of this happening.
Now, with the PSA data being removed because of quality control problems we have more evidence that the USPTF has made a very bad decision.
According to the NCI internal checks revealed that a substantial number of PSA values included in the programs were incorrect. An editorial published in The Journal of Urology explored the ramifications of the removal of these data for not only clinicians but also researchers and administrators. These findings also call into question the use and accuracy of large administrative datasets in general. Thus this disclosure from the NCI has wide ranging ramifications for men
We don’t know how many of our assumptions, or I should probably say data points are flawed. We don’t know if the removal of the flawed actually would have affected the decisions of the USFTF. As I mentioned before, many people in the know have feared the results of the USFTF decision. Now it seems like a slap in the face that the bad decisions by the USFTF might actually have not been made if the SEER data had been eliminated earlier.
Will the USPTF review their decision? I certainly hope so, but I remain very cynical. I guess that only time will tell.
Joel T. Nowak, M.A., M.S.W.