J Clin Outcomes Manage
Update on prostate cancer screening
McCormick KA, Osman NY, Pomerantz MM
Abstract Objective: To provide an overview of the evidence examining the risks and benefits of prostate cancer screening with prostate-specific antigen (PSA). Methods: Review of the literature. Results: Prostate cancer poses a significant health burden in the United States. Screening for prostate cancer with PSA, although controversial, is common in the primary care setting. PSA-based screening is criticized for its low specificity, with many false-positive results. Screening also commonly results in the diagnosis of clinically insignificant prostate cancer, exposing many men to unnecessary treatments with potentially significant side effects. There is substantial indirect evidence to support a mortality benefit for screening, possibly justifying the use of PSA despite its shortcomings. However, randomized controlled trials to date have not definitively established that PSA-based screening reduces the rate of death from prostate cancer. Other areas of controversy include the age at which to start screening, particularly among those at increased risk based on race or family history. The optimal PSA threshold at which to refer for biopsy is also widely debated. Considerable efforts have been made to incorporate other laboratory variables to improve the performance of the PSA test. Conclusions: Prostate cancer screening is a common practice in the United States. While there is likely at least a modest mortality benefit to screening, this comes at the cost of diagnosing and treating clinically insignificant prostate cancer. Prior to screening, primary care providers should have a discussion with patients about the potential risks and benefits, helping patients to make an informed, values-based decision.
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