To our readers:
As we sit here today, the nation is transfixed by the debate raging in the federal government over the various bills to remedy the health care crisis. No one seems to dispute that there is a crisis, though there are legitimate arguments about the ways in which to overhaul the system.
Some of the problems stem from the proliferation of tests without adequate validation and guidelines, and with unproven or unclear efficacy, but with large and growing costs. A classic example of this problem is the diagnosis and treatment of prostate cancer, where controversy surrounds every step of the process, from whether screening with prostate specific antigen (PSA) should be done at all, to under what circumstances it should be done, what level of serum PSA should be considered positive enough to warrant a diagnostic biopsy, which prostate cancers should even be treated if diagnosed, and if treated which of a growing assortment of surgical and increasingly expensive radiotherapeutic modalities should be utilized as primary therapy. While all of this leads to significant increased morbidity (and further expense), there is uncertainty as to the benefits.
Two large randomized trials, the gold standard of medical clinical research, were undertaken more than a decade ago with a combined total of over 200,000 men participating and both reported their initial results recently. As luck would have it, their results appear to conflict, and the student of this subject probably remains free to believe whatever he chooses.
In this issue of our Newsletter, we present a pro and con discussion of the studies and allow our readers some insight into the debate.
The Editors
Alfred I. Neugut, M.D., Ph.D.
Myron M. Studner Professor of Cancer Research
Professor of Medicine and Epidemiology
Associate Director for Population Sciences
Herbert Irving Comprehensive Cancer Center
Columbia University College of Physicians and Surgeons
and Mailman School of Public Health
Co-Director, Cancer Prevention Program
NewYork-Presbyterian Cancer Centers
Andrew J. Dannenberg, M.D.
Henry R. Erle, MD-Roberts Family Professor of Medicine
Cancer Center Director
Weill Cornell Medical College
Co-Director, Cancer Prevention Program
New York-Presbyterian Cancer Centers
