I’m 44 years old and part way through a combined EBRT and brachytherapy treatment programme for prostate cancer. A routine work medical detected a slightly elevated PSA (4.2). After being retested some months later, and a biopsy, the diagnosis was made. I have no family history, so the inclusion of the PSA test in the medical was random and, in my mind, fortuitous. My own GP told me he never includes PSA tests in a routine medical for an under 50 year old, unless there are special circumstances.

The views of Associate Professor Richardson (in the February 11 and February 25 issues of the Journal) on prostate cancer screening, supported (although Nazi references to criticise another’s position are better described as unfortunate and intemperate) by Dr Corwin, seem flawed to me.

Screening programmes, like any form of population sampling, has a risk of bias. Politicians, marketers, credit card companies, researchers, and other users of sample data know this. But that doesn’t stop them gathering sample data and then making adjustments to ameliorate bias risks, or applying standard statistical techniques so as to not overstate the confidence that can be had in the analysis.

We’d live in much less well-informed world if use were only ever made of data that are free from any bias or analysis of which we are 100% confident.

The real issues, from a patient perspective, are:

My own experience is that the options and risks were well explained, there is plenty of readily accessible literature, and the final choice was mine. Even the possibility of histological error was explored.

Associate Professor Richardson may be right in her contention that treatment of early prostate cancer has uncertain benefits, and in a year or two I might wish not to have the side effects of treatment.

But far more certainly she is wrong to suppose, as she implicitly does, that for my own sake I shouldn’t have had the chance to make that choice, or that I had insufficient information to make it rationally.