Reply from Authors re: Michael Baum. Screening for Prostate Cancer: Can We Learn from the Mistakes of the Breast Screening Experience? Eur Urol 2013;64:540–1: Screening for Prostate Cancer: We Have Learned and Are Still Learning

Abstract

for cancer. I was one of the architects of the National Health Service Breast Screening Programme (NHSBSP) in the United Kingdom in the late 1980s and also have enjoyed the privilege of acting as independent chairman of the Prostate Testing for Cancer and Treatment (ProtecT) trial of PCa screening in the United Kingdom for the last 12 yr [3]. I was also one of the first to break ranks with the NHSBSP as emergingdata started to suggest that breast cancer screening was failing to liveup to itspromise.Most recently, I published a paper in the BMJ inwhich I returned to basics and posed the question in the introduction of the editorial, ‘‘Does screening for breast cancer improve LoL andorQoL?’’ The answerwas a resounding no [4]. If we are not to repeat the errors of the past, then all cancer-screening trials must be reported using absolute numbers, numbers needed to screen to avoid a causespecific death, all-cause mortality, and some measure of QoL. Impotence and incontinence might be good surrogates for the latter. Some biostatisticians get very cross with me when they argue that the trials were not powered to determine any impact on all-cause deaths. Yet hundreds of thousands of men have been randomised in screening trials, so if the signal has been lost in the background noise, it must be a very small signal. If that is indeed the case, there is the issue of opportunity costs when the same money might be used with greater wisdom to save more lives. I am confident that the ProtecT trial will not repeat the mistakes of the past.