The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Prostate Cancer Screening: What We Know and What We Need To Know

Barnett S. Kramer, MD, MPH; Martin L. Brown, PhD; Philip C. Prorok, PhD; Arnold L. Potosky, MHS; and John K. Gohagan, PhD
[+] Article, Author, and Disclosure Information

From the Division of Cancer Prevention and Control, National Cancer Institute, Bethesda, Maryland. Acknowledgments: The authors thank Drs. Paul Schellhammer (urology), Ian Thompson (urology), Donald Henson (pathology), and Peter Greenwald (public health) for the critical review and comments on the manuscript.

Copyright 2004 by the American College of Physicians

Ann Intern Med. 1993;119(9):914-923. doi:10.7326/0003-4819-119-9-199311010-00009
Text Size: A A A

Objective: To critically evaluate the evidence for recommending the screening of asymptomatic men for prostate cancer with a blood test to detect a prostate-specific antigen (PSA).

Data Sources: Relevant articles on screening for prostate cancer were identified from MEDLINE searches, from the authors' files, and from the bibliographies of identified articles.

Study Selection: In the absence of controlled prospective trials, the studies are primarily retrospective and contain information about the sensitivity, specificity, and predictive values of tests used to screen for prostate cancer; the natural history of untreated prostate cancer; the morbidity, mortality, and costs of definitive treatment; and reviews of screening study biases.

Data Extraction: Potential treatment-related mortality and costs that could be incurred by screening were estimated using defined assumptions.

Results: Although screening for prostate cancer has the potential to save lives, because of possible over-diagnosis, screening and subsequent therapy could actually have a net unfavorable effect on mortality or quality of life or both. Given the performance characteristics of the test, widespread screening efforts would probably cost billions of dollars.

Conclusions: The net benefit from widespread screening is unclear. A randomized prospective study of the effect of screening on prostate cancer mortality has therefore been initiated by the National Cancer Institute.


Grahic Jump Location
Figure 3.
Length bias.

Symptomatic interval cases are biologically more aggressive than screen-detected cases. Sx = symptoms.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.