Prostate Cancer Screening — A Perspective on the Current State of the Evidence

Published on Mar 30, 2017in The New England Journal of Medicine70.67
· DOI :10.1056/NEJMsb1616281
Paul F. Pinsky53
Estimated H-index: 53
Philip C. Prorok39
Estimated H-index: 39
Barnett S. Kramer56
Estimated H-index: 56
Controversy continues to roil around the role of PSA screening in prostate cancer. The authors review the available data and its quality and conclude that the evidence does not indicate that the benefits outweigh the harms.
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BACKGROUND Two large-scale prostate cancer screening trials using prostate-specific antigen (PSA) have given conflicting results in terms of the efficacy of such screening. One of those trials, the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, previously reported outcomes with 13 years of follow-up. This study presents updated findings from the PLCO trial. METHODS The PLCO trial randomized subjects from 1993 to 2001 to an intervention or control arm. Intervention-arm men...
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#2Jiemin Ma (ACS: American Cancer Society)H-Index: 22
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#1Freddie C. Hamdy (University of Oxford)H-Index: 71
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BackgroundThe comparative effectiveness of treatments for prostate cancer that is detected by prostate-specific antigen (PSA) testing remains uncertain. MethodsWe compared active monitoring, radical prostatectomy, and external-beam radiotherapy for the treatment of clinically localized prostate cancer. Between 1999 and 2009, a total of 82,429 men 50 to 69 years of age received a PSA test; 2664 received a diagnosis of localized prostate cancer, and 1643 agreed to undergo randomization to active m...
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The Choosing Wisely ® initiative is a national campaign led by the American Board of Internal Medicine Foundation, focused on quality improvement and advancing a dialogue on avoiding wasteful or unnecessary medical tests, procedures, and treatments. The American College of Preventive Medicine (ACPM) Prevention Practice Committee is an active participant in the Choosing Wisely project. The committee created the ACPM Choosing Wisely Task Force to lead the development of ACPM's recommendations with...
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Ian Haines and colleagues call for access to all the publicly funded clinical trial data from two major trials to settle the controversies around screening for prostate cancer with prostate specific antigen
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The PLCO trial generated data that argue against PSA screening. However, participants in the control group also reported being screened. An analysis of health questionnaires suggests that more than 80% of controls had been tested within the previous 3 years.
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In recent years, several new biomarkers supplementing the role of prostate-specific antigen (PSA) have become available for men with prostate cancer. Although widely used in an ad hoc manner, the role of PSA in screening asymptomatic men for prostate cancer is controversial. Several expert panels, however, have recently recommended limited PSA screening following informed consent in average-risk men, aged 55-69 years. As a screening test for prostate cancer however, PSA has limited specificity a...
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