Alfred O. Berg, MD, MPH
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Berg AO. Screening for Prostate Cancer. Ann Intern Med. 2003;139:532. doi: 10.7326/0003-4819-139-6-200309160-00031
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Published: Ann Intern Med. 2003;139(6):532.
Drs. Smith and Robertson share the common view that all prostate cancer, if left alone, will grow, spread, and kill. This is fortunately not the case. Some cancerous prostate tumors clearly grow and spread with devastating consequences, as both correspondents remind us, but most do not. The core of the difficulty is that clinicians cannot tell which is which at the time of diagnosis following a positive result on a screening test.
Autopsy studies show that approximately 30% of men at age 50 years, 50% of men at age 70 years, and almost all men by age 100 years have histologic cancer in the prostate. Thus, the tendency to recommend treatment for all men with a diagnosis of prostate cancer undoubtedly appropriately treats some but also harms those whose cancer could safely have been left alone. Even men who choose watchful waiting live with the awareness of having prostate cancer. In either case—treatment or watchful waiting—some men may suffer more harm than good from screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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