I enjoyed the recent article by Dr. Neugut on the Labrie affair (“The Labrie Study: A Statistical Error?” March 22, 2022), but would add this comment.

Even if you recall that memorable 1998 presentation by colleagues from Quebec, the finding of a poorly designed statistical analysis of clinical data does not detract from the historical importance of the discovery of prostate-specific antigen (PSA) in the overall understanding of treatment of prostate cancer.

PSA is the only biomarker that can indicate the presence of small, confined, early malignant tumors that elude the doctor’s detecting digit and often, even the fine “eye” of the larger magnets of our MRI modules. That first elevation of a carefully followed PSA can be the only indicator of a confined, even aggressive, malignancy that needs rapid treatment—surgery or radiation—depending on age and other clinical factors. There are retrospective clinical studies that demonstrate longer survival in early, rather than late, detected, otherwise comparable, sub-groups.

I think that this interesting comment about a poorly designed study is a bit similar to missing the forest for a momentarily interesting tree, when focus on the forest might turn out, in this case, to be giving praise where praise is due. The development and use of PSA has revolutionized the medical profession’s entire orientation to evidence-based cancer detection and the value of early treatment.