Last Saturday I had the distinct privilege of listening to Dr. Fritz Schröder (above) during a one-hour lecture on prostate cancer screening at the United Services University in Bethesda, Maryland. If you don’t know his name, than you at least know his research. Schröder’s the lead author of the European Randomized Study of Screening for Prostate Cancer (ERSPC) initiative. The New England Journal of Medicine released the ERSPC’s 11 year data in March. [1] You’ve probably also read his paper analyzing the effects of prostate-specific antigen (PSA) screening on the risk of developing metastatic prostate cancer, which European Urology published in November. [2] These are two landmark papers in the field of urology.
Schröder’s research is unprecedented in prostate cancer screening. He has published in the world’s most critical and impactful medical journals. His research provides convincing evidence that PSA-based prostate cancer screening saves lives. His contribution to urology is immeasurable.
However, when you consider Saturday’s lecture in its entirety, the research–the sheer numbers, percentages, and statistics–was far from the most impressive part.
Before the United States Preventative Services Task Force (USPSTF) issued their Grade D recommendation PSA-based screening for prostate cancer [3] , it reviewed the 11 year ERSPC data. At least the USPSTF should have reviewed the data: Schröder sent the USPSTF his updated ERSPC data and abstract before the USPSTF decision. Nevertheless, the USPSTF published their recommendations against PSA screening. The field of urology treads in the wake of the decision.
During Saturday’s lecture, Schröder stayed above the politics. He didn’t insult the USPSTF or undermine their authority. Schröder simply stated his data didn’t agree. He also said, “I don’t expect new data from the PLCO.” (The Prostate, Lung, Colorectal, Ovarian Cancer Screening Trial is a separate, American investigation into prostate cancer screening. The USPSTF used the PLCO as the foundation for their recommendation. Here’s the punchline: The PLCO is unanimously accepted as a flawed investigation into PSA-based screening. You must understand the dire shortcomings of the PLCO trial to appreciate the humility, grace, and comedy of Schröder’s statement.)
What would you do if you had completed the most comprehensive and arguably “best” prostate cancer screening study in the world only to have the USPSTF ignore it outright? Would you go on a tirade about how the USPSTF played politics and, in the process, likely adversely affected the cancer-specific health of millions of men across America?
Or would you say, “The data doesn’t agree,” liberating resolution to the autonomous, scientific minds.
Schröder is a true scientist. Science stands above politics, which is exactly why urologists are listening to Schröder, not the USPSTF.
My urology career is in its infancy, but this lecture will be a bookmark.
- N Engl J Med. 2012 Mar 15;366(11):981-90.
- Eur Urol. 2012 Nov;62(5):745-52.
- Ann Intern Med. 2012 Jul 17;157(2):120-34.
