Correspondence
Philip E Castle All authors agree that the main 2 Vickers AJ, Ulmert D, Sjoberg DD, et al. Strategy
for detection of prostate cancer based on
drawback of PSA-based screening is relation between prostate specific antigen at
Department of Epidemiology and Population overtreatment of indolent lesions. age 40-55 and long term risk of metastasis:
Health, Albert Einstein College of Medicine, New However, overtreatment can also be case-control study. BMJ 2013; 346: f2023.
York, NY 10461, USA 3 Eeles RA, Olama AA, Benlloch S, et al.
minimised by better triage algorithms Identification of 23 new prostate cancer
1 Cuzick J, Thorat MA, Andriole G, et al.
Prevention and early detection of prostate
based on the progressive potential susceptibility loci using the iCOGS custom
genotyping array. Nat Genet 2013; 45: 385–91.
cancer. Lancet Oncol 2014; 15: e484–e92. by use of information available from
4 Cuzick J, Berney DM, Fisher G, et al. Prognostic
2 The Surveillance, Epidemiology, and End a needle biopsy. Needle biopsy, value of a cell cycle progression signature for
Results (SEER) Program. http://seer.cancer.
gov/ (accessed Oct 15, 2014). although painful, does not carry the prostate cancer death in a conservatively
managed needle biopsy cohort. Br J Cancer
3 Schröder FH, Hugosson J, Roobol MJ, et al. morbidity of radical treatment, and 2012; 106: 1095–99.
Screening and prostate cancer mortality: assessment of disease characteristics 5 Castle PE, Sideri M, Jeronimo J, Solomon D,
results of the European Randomised Study of
from this sample is very likely to be Schiffman M. Risk assessment to guide the
Screening for Prostate Cancer (ERSPC) at
prevention of cervical cancer.
13 years of follow-up. Lancet 2014; published more informative than assessments Am J Obstet Gynecol 2007; 197: 356.
online Aug 6. http://dx.doi.org/10.1016/
S0140-6736(14)60525-0. based on blood or even urine. The
4 Pinsky PF, Blacka A, Kramer BS, Miller A, technique offers an opportunity to
Prorok PC, Berg C. Assessing contamination
and compliance in the prostate component of
focus radical treatment on those who Lung cancer screening
truly will benefit from it. Our work
the Prostate, Lung, Colorectal, and Ovarian
(PLCO) cancer screening trial. Clin Trials 2010; on a cell-cycle progression score
with low-dose CT: more
5
7: 303–11.
Moyer VA. Screening for prostate cancer: US
substantially moves this approach questions than answers
Preventive Services Task Force forward,4 and greatly increases
recommendation statement. Ann Intern Med the number of men who can be After reading the Comment by
2012; 157: 120–34.
6 Kovalchik SA, Tammemagi M, Berg CD, et al. safely managed by conservative Mulshine and Henschke1 on the
Targeting of low-dose CT screening according methods. More work in this area will NELSON study,2,3 we are surprised
to the risk of lung-cancer death. N Engl J Med
2013; 369: 245–54.
probably further refine risk-adapted by the misleading interpretation
7 Tice JA, Cummings SR, Smith-Bindman R, management algorithms, and this of the results of both studies. We
Ichikawa L, Barlow WE, Kerlikowske K. Using will be essential in developing ways to note that the message in the title of
clinical factors and mammographic breast
density to estimate breast cancer risk: reduce mortality from prostate cancer the Comment (“achieving more by
development and validation of a new while minimising screening-induced intervening less”) is not explained in
predictive model. Ann Intern Med 2008;
148: 337–47.
morbidity. the text. The main conclusion of the
The use of risk-based algorithms first NELSON study was that nodules
to guide early detection and smaller than 100 mm³ or 5 mm in
Authors’ reply management, as promoted by diameter should not be deemed
We thank Philip Castle for his Castle for cervical screening,5 is predictive for lung cancer;2 therefore,
insightful comments. Our group essential for the development of the investigators suggested that a
struggled with the strengths and a rational approach to minimising 2 year screening for these individuals
weaknesses of prostate-specific the mortality and morbidity from might be safe. The investigators also
antigen (PSA) screening and most prostate cancer. suggested that volumetric assessment
of us also recognised a potential JC reports grants from Cancer Research UK, Prostate instead of diametric assessment
that should not be dismissed.1 We Cancer UK, and the Association for International might be advantageous for the
Cancer Research, during this study; grants and
also noted that several extensions of classification of lung nodules as
personal fees from Myriad Genetics; personal fees
PSA and modifications like a higher and non-financial support from Bayer; and positive or negative.
PSA threshold and lower screening membership of the advisory board of Myriad Mulshine and Henschke do not
frequency offer the potential for Genetics and Bayer, outside the submitted work. mention the possibility of a 2-year
MAT reports grants from Cancer Research UK,
better screening performance.1 Prostate Cancer UK, and the Association for screening interval for these small
Castle’s risk-based stratification International Cancer Research, during the conduct nodules. This cutpoint also suggests
suggestion is interesting, although of the study. increased cost-effectiveness and
one PSA test at a young age might Jack Cuzick, Mangesh A Thorat fewer adverse effects (through
still be one of the best ways to obtaining fewer false positives and
stratify individuals or intervals Centre for Cancer Prevention, Wolfson Institute of work-up diagnostic procedures).
for subsequent screening.2 Other Preventive Medicine, Barts and The London School Perhaps this omission is due to the
of Medicine and Dentistry, Queen Mary University
potential risk-stratification strategies Comment only citing results from
of London, London, UK
include family history, race, and other the National Lung Screening Trial
1 Cuzick J, Thorat MA, Andriole G, et al.
risk factors,1 and methods like a panel Prevention and early detection of prostate (NLST) and I-ELCAP. The I-ELCAP
of SNPs.3 cancer. Lancet Oncol 2014; 15: e484–92. study, of which Henschke is the
www.thelancet.com/oncology Vol 16 January 2015 e3
Philip E Castle All authors agree that the main 2 Vickers AJ, Ulmert D, Sjoberg DD, et al. Strategy
for detection of prostate cancer based on
drawback of PSA-based screening is relation between prostate specific antigen at
Department of Epidemiology and Population overtreatment of indolent lesions. age 40-55 and long term risk of metastasis:
Health, Albert Einstein College of Medicine, New However, overtreatment can also be case-control study. BMJ 2013; 346: f2023.
York, NY 10461, USA 3 Eeles RA, Olama AA, Benlloch S, et al.
minimised by better triage algorithms Identification of 23 new prostate cancer
1 Cuzick J, Thorat MA, Andriole G, et al.
Prevention and early detection of prostate
based on the progressive potential susceptibility loci using the iCOGS custom
genotyping array. Nat Genet 2013; 45: 385–91.
cancer. Lancet Oncol 2014; 15: e484–e92. by use of information available from
4 Cuzick J, Berney DM, Fisher G, et al. Prognostic
2 The Surveillance, Epidemiology, and End a needle biopsy. Needle biopsy, value of a cell cycle progression signature for
Results (SEER) Program. http://seer.cancer.
gov/ (accessed Oct 15, 2014). although painful, does not carry the prostate cancer death in a conservatively
managed needle biopsy cohort. Br J Cancer
3 Schröder FH, Hugosson J, Roobol MJ, et al. morbidity of radical treatment, and 2012; 106: 1095–99.
Screening and prostate cancer mortality: assessment of disease characteristics 5 Castle PE, Sideri M, Jeronimo J, Solomon D,
results of the European Randomised Study of
from this sample is very likely to be Schiffman M. Risk assessment to guide the
Screening for Prostate Cancer (ERSPC) at
prevention of cervical cancer.
13 years of follow-up. Lancet 2014; published more informative than assessments Am J Obstet Gynecol 2007; 197: 356.
online Aug 6. http://dx.doi.org/10.1016/
S0140-6736(14)60525-0. based on blood or even urine. The
4 Pinsky PF, Blacka A, Kramer BS, Miller A, technique offers an opportunity to
Prorok PC, Berg C. Assessing contamination
and compliance in the prostate component of
focus radical treatment on those who Lung cancer screening
truly will benefit from it. Our work
the Prostate, Lung, Colorectal, and Ovarian
(PLCO) cancer screening trial. Clin Trials 2010; on a cell-cycle progression score
with low-dose CT: more
5
7: 303–11.
Moyer VA. Screening for prostate cancer: US
substantially moves this approach questions than answers
Preventive Services Task Force forward,4 and greatly increases
recommendation statement. Ann Intern Med the number of men who can be After reading the Comment by
2012; 157: 120–34.
6 Kovalchik SA, Tammemagi M, Berg CD, et al. safely managed by conservative Mulshine and Henschke1 on the
Targeting of low-dose CT screening according methods. More work in this area will NELSON study,2,3 we are surprised
to the risk of lung-cancer death. N Engl J Med
2013; 369: 245–54.
probably further refine risk-adapted by the misleading interpretation
7 Tice JA, Cummings SR, Smith-Bindman R, management algorithms, and this of the results of both studies. We
Ichikawa L, Barlow WE, Kerlikowske K. Using will be essential in developing ways to note that the message in the title of
clinical factors and mammographic breast
density to estimate breast cancer risk: reduce mortality from prostate cancer the Comment (“achieving more by
development and validation of a new while minimising screening-induced intervening less”) is not explained in
predictive model. Ann Intern Med 2008;
148: 337–47.
morbidity. the text. The main conclusion of the
The use of risk-based algorithms first NELSON study was that nodules
to guide early detection and smaller than 100 mm³ or 5 mm in
Authors’ reply management, as promoted by diameter should not be deemed
We thank Philip Castle for his Castle for cervical screening,5 is predictive for lung cancer;2 therefore,
insightful comments. Our group essential for the development of the investigators suggested that a
struggled with the strengths and a rational approach to minimising 2 year screening for these individuals
weaknesses of prostate-specific the mortality and morbidity from might be safe. The investigators also
antigen (PSA) screening and most prostate cancer. suggested that volumetric assessment
of us also recognised a potential JC reports grants from Cancer Research UK, Prostate instead of diametric assessment
that should not be dismissed.1 We Cancer UK, and the Association for International might be advantageous for the
Cancer Research, during this study; grants and
also noted that several extensions of classification of lung nodules as
personal fees from Myriad Genetics; personal fees
PSA and modifications like a higher and non-financial support from Bayer; and positive or negative.
PSA threshold and lower screening membership of the advisory board of Myriad Mulshine and Henschke do not
frequency offer the potential for Genetics and Bayer, outside the submitted work. mention the possibility of a 2-year
MAT reports grants from Cancer Research UK,
better screening performance.1 Prostate Cancer UK, and the Association for screening interval for these small
Castle’s risk-based stratification International Cancer Research, during the conduct nodules. This cutpoint also suggests
suggestion is interesting, although of the study. increased cost-effectiveness and
one PSA test at a young age might Jack Cuzick, Mangesh A Thorat fewer adverse effects (through
still be one of the best ways to obtaining fewer false positives and
stratify individuals or intervals Centre for Cancer Prevention, Wolfson Institute of work-up diagnostic procedures).
for subsequent screening.2 Other Preventive Medicine, Barts and The London School Perhaps this omission is due to the
of Medicine and Dentistry, Queen Mary University
potential risk-stratification strategies Comment only citing results from
of London, London, UK
include family history, race, and other the National Lung Screening Trial
1 Cuzick J, Thorat MA, Andriole G, et al.
risk factors,1 and methods like a panel Prevention and early detection of prostate (NLST) and I-ELCAP. The I-ELCAP
of SNPs.3 cancer. Lancet Oncol 2014; 15: e484–92. study, of which Henschke is the
www.thelancet.com/oncology Vol 16 January 2015 e3
