PROSTATE-CANCER SCREENING - A DECISION-ANALYSIS

Background. The issue of whether to screen men for prostate cancer is controversial. No randomized clinical trials have been completed to co nfirm the efficacy of screening for prostate cancer. We created a math ematical model of the clinical risks and benefits of screening for pro state cancer. Methods. A Markov decision-analytic model evaluated the outcomes of annually screening asymptomatic men for prostate cancer be ginning at age 50 years. The screening and testing algorithm included the digital rectal examination, transrectal ultrasound, and prostate-s pecific antigen test. A sample of 10 male patients with no history of prostate disease were interviewed to assess their utilities (preferenc es) regarding the various adverse outcomes of prostate cancer treatmen t. Results. The model indicated that no screening was preferred to scr eening when patients' utilities were considered (24.14 vs 23.47 qualit y-adjusted life years expected). The optimal decision was sensitive to the utilities of impotence and urethral stricture, the most common ad verse outcomes for patients under the age of 65 years. When adverse ou tcomes of treatment were ignored, screening was favored (24.86 vs 24.2 2 years of life expectancy). Conclusions. When quality-of-life prefere nces of men are considered, the annual screening of asymptomatic patie nts for prostate cancer is not recommended.