Prostate cancer screening : what we know and what we need to know

• Published in: Annals of internal medicine Vol. 119; no. 9; pp. 914 - 923
• Main Authors: KRAMER, B. S, BROWN, M. L, PROROK, P. C, POTOSKY, A. L, GOHAGAN, J. K
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American College of Physicians 01-11-1993
• Subjects: Aged; Biological and medical sciences; General aspects; Health Care Costs; History of medicine; History, 20th Century; Humans; Male; Mass Screening - economics; Mass Screening - methods; Medical sciences; Middle Aged; Planification. Prevention (methods). Intervention. Evaluation; Prostate-Specific Antigen - blood; Prostate-Specific Antigen - history; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - mortality; Prostatic Neoplasms - prevention & control; Public health. Hygiene; Public health. Hygiene-occupational medicine; United States - epidemiology; United States; North America; America; Performance evaluation; Human; Prevention; Randomization; Prognosis; Mortality; Malignant tumor; Medical screening; Prostate; Public health
• ISSN: 0003-4819; 1539-3704
• DOI: 10.7326/0003-4819-119-9-199311010-00009

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).
Relevant articles on screening for prostate cancer were identified from MEDLINE searches, from the authors' files, and from the bibliographies of identified articles.
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.
Potential treatment-related mortality and costs that could be incurred by screening were estimated using defined assumptions.
Although screening for prostate cancer has the potential to save lives, because of possible overdiagnosis, 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.
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.