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Ann Intern Med. 1993 Nov 1;119(9):914-23.

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

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  • 1Division of Cancer Prevention and Control, National Cancer Institute, Bethesda, Maryland.

Abstract

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 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.

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.

Comment in

PMID:
7692780
[PubMed - indexed for MEDLINE]
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