PROSTATE-CANCER SCREENING - WHAT WE KNOW AND WHAT WE NEED TO KNOW

Objective: To critically evaluate the evidence for recommending the sc reening of asymptomatic men for prostate cancer with a blood test to d etect a prostate-specific antigen (PSA). Data Sources: Relevant articl es on screening for prostate cancer were identified from MEDLINE searc hes, from the authors' files, and from the bibliographies of identifie d articles. Study Selection: In the absence of controlled prospective trials, the studies are primarily retrospective and contain informatio n about the sensitivity, specificity, and predictive values of tests u sed to screen for prostate cancer; the natural history of untreated pr ostate cancer; the morbidity, mortality, and costs of definitive treat ment; and reviews of screening study biases. Data Extraction: Potentia l treatment-related mortality and costs that could be incurred by scre ening were estimated using defined assumptions. Results: Although scre ening for prostate cancer has the potential to save lives, because of possible over-diagnosis, screening and subsequent therapy could actual ly have a net unfavorable effect on mortality or quality of life or bo th. Given the performance characteristics of the test, widespread scre ening efforts would probably cost billions of dollars. Conclusions: Th e net benefit from widespread screening is unclear. A randomized prosp ective study of the effect of screening on prostate cancer mortality h as therefore been initiated by the National Cancer Institute.