0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Position Papers |

CLINICAL GUIDELINES: PART II: Early Detection of Prostate Cancer: Part II: Estimating the Risks, Benefits, and Costs

Christopher M. Coley, MD; Michael J. Barry, MD; Craig Fleming, MD; Marianne C. Fahs, PhD; and Albert G. Mulley, MD, MPP
[+] Article and Author Information

From Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Mount Sinai School of Medicine, New York, New York; and Health Outcomes Associates, Vancouver, Washington. Note: Much of the analytic work presented in this paper is that of the Patient Outcomes Research Team for Prostatic Diseases and was done under contract K3-0546.0 from the Office of Technology Assessment, Congress of the United States. The conclusions are solely those of the authors and do not represent the views of the Office of Technology Assessment, the Technology Assessment Board, or the United States Congress. Grant Support: In part by grant HS-08397 from the Agency for Health Care Policy and Research (Patient Outcomes Research Team for Prostatic Diseases). Requests for Reprints: Michael J. Barry, MD, Medical Practices Evaluation Center, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114. Current Author Addresses: Dr. Coley: Harvard University Health Services, 75 Mount Auburn Street, Cambridge, MA 02138.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;126(6):468-479. doi:10.7326/0003-4819-126-6-199703150-00010
Text Size: A A A

Purpose: To evaluate the potential benefits, harms, and economic consequences of digital rectal examination and measurement of prostate-specific antigen (PSA) for the early detection of prostate cancer.

Data Sources: Relevant studies were identified from a MEDLINE search (1966 to 1995), reviews, bibliographies of retrieved articles, author files, and abstracts.

Study Selection: Probabilities for individual clinical outcomes were derived from various sources, including the largest screening study of community volunteers to date, analyses of Medicare claims, and recently published meta-analyses of the outcomes of alternative treatment strategies. Cost estimates were based on the 1992 Medicare fee schedule.

Data Extraction: A cost-effectiveness model for one-time digital rectal examination and PSA measurement was constructed to examine the possible outcomes.

Results: If a favorable set of assumptions is used, one-time digital rectal examination and PSA measurement may increase average life expectancy by approximately 2 weeks at a reasonable marginal cost for men who are between 50 and 69 years of age. Considerable iatrogenic illness would occur. If less favorable assumptions are used, the estimated net benefit would decrease and cost-effectiveness ratios would dramatically increase. Even if favorable assumptions are used, the model suggests that screening adds only a few days to the average life expectancy of men who are older than 69 years of age. If the assumptions are less favorable, older men are harmed.

Conclusions: The model suggests that screening may be reasonable in younger men if optimistic assumptions consistent with existing observational data are made. The lack of direct evidence showing a net benefit of screening for prostate cancer seems to mandate more clinician-patient discussion for this procedure than for many other routine tests.

Figures

Tables

References

Letters

NOTE:
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).

Comments

Submit a Comment
Submit a Comment

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.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
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.
(Required)
(Required)