Kenneth Lin, MD; Robert Lipsitz, MD, MPH; Therese Miller, DrPH; Supriya Janakiraman, MD, MPH
Acknowledgment: The authors thank Caryn McManus at the Agency for Healthcare Research and Quality for her assistance with the literature searches.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Kenneth Lin, MD, Center for Primary Care, Prevention, and Clinical Partnerships, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Lin, Lipsitz, Miller, and Janakiraman: 540 Gaither Road, Rockville, MD 20850.
Prostate cancer is the most common nonskin cancer in men in the United States, and prostate cancer screening has increased in recent years. In 2002, the U.S. Preventive Services Task Force concluded that evidence was insufficient to recommend for or against screening for prostate cancer with prostate-specific antigen (PSA) testing.
To examine new evidence on benefits and harms of screening asymptomatic men for prostate cancer with PSA.
English-language articles identified in PubMed and the Cochrane Library (search dates, January 2002 to July 2007), reference lists of retrieved articles, and expert suggestions.
Randomized, controlled trials and meta-analyses of PSA screening and cross-sectional and cohort studies of screening harms and of the natural history of screening-detected cancer were selected to answer the following questions: Does screening for prostate cancer with PSA, as a single-threshold test or as a function of multiple tests over time, decrease morbidity or mortality? What are the magnitude and nature of harms associated with prostate cancer screening, other than overtreatment? What is the natural history of PSA-detected, nonpalpable, localized prostate cancer?
Studies were reviewed, abstracted, and rated for quality by using predefined U.S. Preventive Services Task Force criteria.
No good-quality randomized, controlled trials of screening for prostate cancer have been completed. In 1 cross-sectional and 2 prospective cohort studies of fair to good quality, false-positive PSA screening results caused psychological adverse effects for up to 1 year after the test. The natural history of PSA-detected prostate cancer is poorly understood.
Few eligible studies were identified. Long-term adverse effects of false-positive PSA screening test results are unknown.
Prostate-specific antigen screening is associated with psychological harms, and its potential benefits remain uncertain.
Analytic framework for screening for prostate cancer.
Appendix Table. U.S. Preventive Services Task Force Hierarchy of Research Design and Quality Rating Criteria
Key question 1: stages of article review.
RCT = randomized, controlled trial.
Key question 2: stages of article review.
Key question 3: stages of article review.
Table 1. Evidence for Key Question 1: Effect of Prostate Cancer Screening on Morbidity and Mortality
Table 2. Evidence for Key Question 2: Harms of PSA Screening
Table 3. Evidence for Key Question 3: Natural History of PSA-Detected, Localized Prostate Cancer
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Lin K, Lipsitz R, Miller T, Janakiraman S. Benefits and Harms of Prostate-Specific Antigen Screening for Prostate Cancer: An Evidence Update for the U.S. Preventive Services Task Force. Ann Intern Med. 2008;149:192–199. doi: 10.7326/0003-4819-149-3-200808050-00009
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Published: Ann Intern Med. 2008;149(3):192-199.
Cancer Screening/Prevention, Guidelines, Hematology/Oncology, Prevention/Screening, Prostate Cancer.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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