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EditorialValentine's Day PSA
A few years ago Barrack Obama, the President of theUSA, is supposed to have said on Valentine’s Day –“Gentlemen – do not forget!”
He was apparently speaking “from experience”. Notremembering that important day can have catastrophicconsequences for many men. On that occasion, PSA stood forpublic service announcement.
The headline, however, could easily have been mistaken forProstate Specific Antigen. One could argue whether the PSAtest is as important to men as Valentine’s Day. Most menprobably do not bother, especially if they are less than 40 yearsold. The PSA debate swings around like a sine wave. Despitethe best possible randomised controlled trials for and againstPSA screening, there seem to be no clear answers with deepdivisions amongst men and their urologists.
This February, the BJUI adds to the PSA debate by publishingthe Melbourne Consensus Statement [1]. It was an attempt tobring some sense to a thorny subject. When published as ablog on www.bjui.org, most of our readers liked it, butcertainly not all. The usual heated debate was inevitable.Earlier last summer Bal Carter, one of our BJUI ExecutiveMembers, chaired the AUA panel that recommended shareddecision making for asymptomatic men between 55–69 years
as far as PSA screening was concerned. They carefullyanalysed over 300 studies to make these recommendations [2].I congratulated Bal on this milestone on the very morning thismade headline news. However, such was the controversy thathe had to present the findings twice – one appearance on theAUA podium was just not enough.
In a well-informed man, over diagnosis is not necessarily aproblem as long as it does not lead to over treatment. I findmyself treating a number of men in their 40s with strongfamily histories of prostate cancer. It is very difficult to denythem a PSA test when they seek it. This discussion is likelyto become redundant in years to come when better riskstratification with genomic tools and improved imaging willcomplement the PSA test, rather than relying on it alone. Inthe meantime I leave it to our knowledgeable readers to makeup their own minds.
Not everyone is interested in the PSA test in the month ofFebruary. If you belong to this category, perhaps we couldgrab your attention with a multi-institutional collaborativestudy showing disease free and overall survival rates of over90% following LESS partial nephrectomy, a challengingprocedure, even for technically accomplished surgeons [3].Khurshid Guru’s group also present data to show that urinaryand bowel domains take about 6 months to recover afterrobotic cystectomy; sexual domains even longer [4].
I have no illusions that none of the above may be of the slightestimportance to some readers. In which case you may wish to headto the best florist in town. Forget that at your peril . . .
Prokar Dasgupta, Editor in Chief, BJUI
Guy’s Hospital, King’s College London
References1 Murphy DG, Ahlering T, Catalona WJ et al. The Melbourne Consensus
Statement on the Early Detection of Prostate Cancer. BJU Int 2014; 113:186–8
2 Carter HB. American Urological Association (AUA) Guideline onprostate cancer detection: process and rationale. BJU Int 2013; 112:543–7
3 Springer C, Greco F, Autorino R et al. Analysis of oncological outcomesand renal function after laparoendoscopic single site partial nephrectomy:a multi-institutional outcome analysis. BJU Int 2014; 113: 266–74
4 Poch MA, Stegemann AP, Rehman S et al. Short-term patient reportedhealth-related quality of life (HRQL) outcomes after robot-assisted radicalcystectomy (RARC). BJU Int 2014; 113: 260–5
© 2014 The AuthorBJU International © 2014 BJU International | doi:10.1111/bju.12605 BJU Int 2014; 113: 177Published by John Wiley & Sons Ltd. www.bjui.org wileyonlinelibrary.com