There are a lot of cancer researchers who think TRANSFORM is misguided, and we need to be doing doing screening using PSA testing now. TRANSFORM is being used an as excuse not to be doing that. Several recent screening trials using PSA testing as part of the current diagnostic pathway which includes MRI before biopsy have shown it isn't over treating, and it's more specific than breast cancer screening, the two criticisms the TRANFORM trial makes of today's PSA blood tests.
The other problem with TRANSFORM is that it requires a control group of men who don't ever have PSA tests (over the 10-20 year life of the trial), and makes the assumption that this is the general population, although it is excluding areas where the NHS has run trial PSA screening programs. Other recent trials of this form have failed, because the men who realised they were part of the control arm decided they weren't going to risk missing out on being cured of early prostate cancer and went and got PSA blood tests, contaminating a large part of the control arm with men who secretly got tested. This completely invalidates the trial results by showing no significant benefit in the screening arms because much of the control arm also got screened. Anyone involved in charity PSA testing knows there's been an enormous uptick in the numbers of men having that done since COVID as more celebs open up about their diagnosis, and also, although GPs are explicitly not allowed to do so, increasing numbers are openly offering PSA blood tests to men without any symptoms. I'm getting many GP's asking me to come and talk at health events they're running, and the most recent one, they are discussing running their own PSA screening at the event, along with all the usual blood pressure, blood glucose, cholesterol etc testing they do there.
There are several presentations today in parliament by researchers who believe we should be rolling out screening using PSA testing now, and not delaying it for another 10-20 year trial, which would result in lots of avoidable deaths, and no valid trial data at the end due to contamination of the control arm. How ethical is a trial which requires a significant number of men to never have a PSA blood test in order to show valid results?