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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 and Author 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
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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.

Figures

Grahic Jump Location
Figure 3.
Length bias.

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

Grahic Jump Location

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