Dr. Jim Hu on Reevaluating PSA and the PLCO Trial

Jim Hu, MD, MPH, director of the LeFrak Center for Robotic Surgery at NewYork-Presbyterian/Weill Cornell Medical Center and the Ronald Lynch Chair of Urologic Oncology at Weill Cornell Medical College, discusses critical flaws in the landmark PLCO trial in prostate cancer.

The PLCO trial, which evaluated the role of PSA in prostate cancer survival, was the basis for the U.S. Preventative Task Force’s recommendation against PSA testing, giving the practice a score of D.

Through an analysis of the PLCO trial, Hu and his team determined that close to 90% of the control arm, which was not supposed to receive PSA testing, did at some point during the trial receive PSA testing. This means that the exposure to PSA testing was virtually the same in both arms, and that the trial results are not accurate, he says.

A randomized trial in Europe with a similar study design as PLCO found a positive association with PSA and overall disease mortality from prostate cancer. This should be further investigated along with the epidemiological data in the U.S. that has that PSA is associated with a decrease in cancer-specific prostate mortality.