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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
Sources
Abstract
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.
  • References (19)
  • Citations (28)
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References19
Newest
#1Paul F. PinskyH-Index: 53
#2Philip C. ProrokH-Index: 39
Last. Gerald L. AndrioleH-Index: 73
view all 9 authors...
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...
57 CitationsSource
#1Ahmedin Jemal (ACS: American Cancer Society)H-Index: 106
#2Jiemin Ma (ACS: American Cancer Society)H-Index: 22
Last. Elizabeth Ward (ACS: American Cancer Society)H-Index: 72
view all 6 authors...
34 CitationsSource
#1Freddie C. Hamdy (University of Oxford)H-Index: 71
#2Jenny L Donovan (UoB: University of Bristol)H-Index: 82
Last. David E. Neal (University of Cambridge)H-Index: 90
view all 27 authors...
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...
718 CitationsSource
#1Catherine J. Livingston (OHSU: Oregon Health & Science University)H-Index: 3
#2Randall J. FreemanH-Index: 2
Last. Kevin M. Sherin (UCF: University of Central Florida)H-Index: 2
view all 7 authors...
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...
7 CitationsSource
#1Ian E. Haines (Monash University)H-Index: 10
#2Richard J. Ablin (UA: University of Arizona)H-Index: 16
Last. George L Gabor MiklosH-Index: 3
view all 3 authors...
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
5 CitationsSource
#1Jonathan E. Shoag (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 2
#2Sameer MittalH-Index: 7
Last. Jim C. HuH-Index: 49
view all 3 authors...
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.
74 CitationsSource
#1Ahmedin Jemal (ACS: American Cancer Society)H-Index: 106
#2Stacey A. Fedewa (ACS: American Cancer Society)H-Index: 34
Last. Elizabeth Ward (ACS: American Cancer Society)H-Index: 72
view all 7 authors...
Importance Prostate cancer incidence in men 75 years and older substantially decreased following the 2008 US Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen (PSA)–based screening for this age group. It is unknown whether incidence has changed since the USPSTF recommendation against screening for all men in May 2012. Objective To examine recent changes in stage-specific prostate cancer incidence and PSA screening rates following the 2008 and 2012 USPSTF re...
218 CitationsSource
#1H. Gilbert Welch (Dartmouth College)H-Index: 60
#2David H. GorskiH-Index: 23
Last. Peter C. Albertsen (UConn: University of Connecticut)H-Index: 63
view all 3 authors...
Discordant trends in the incidence of metastatic breast and prostate cancer since the widespread implementation of early-detection efforts may reflect distinct disease dynamics or may result from the different screening strategies used.
93 CitationsSource
#1Michael W. Drazer (U of C: University of Chicago)H-Index: 10
#2Dezheng Huo (U of C: University of Chicago)H-Index: 52
Last. Scott E. Eggener (U of C: University of Chicago)H-Index: 53
view all 3 authors...
Purpose In 2012, the US Preventive Services Task Force (USPSTF) discouraged prostate-specific antigen (PSA) –based prostate cancer screening. Previous USPSTF recommendations did not appreciably alter prostate cancer screening. Therefore, we designed a trend analysis to determine the population-based impact of the 2012 recommendation. Methods The nationally representative National Health Interview Survey was used to estimate the proportion of men age 40 years and older who saw a physician and wer...
106 CitationsSource
#1Leonard P. Bokhorst (EUR: Erasmus University Rotterdam)H-Index: 11
#2Lionne D. F. Venderbos (EUR: Erasmus University Rotterdam)H-Index: 10
Last. Monique J. Roobol (EUR: Erasmus University Rotterdam)H-Index: 61
view all 6 authors...
Purpose: We assessed differences in treatment between the screening and control arms of ERSPC Rotterdam and studied whether possible treatment differences could explain the positive study outcome.Materials and Methods: In ERSPC Rotterdam men 55 to 74 years old were randomized to a screening arm of 21,210 and a control arm of 21,166. Treatment after diagnosis was at the discretion of the care provider chosen by the patient. Initial treatment was compared in 4 risk groups. The relation between pro...
5 CitationsSource
Cited By28
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#1Hsin-Yao Wang (Memorial Hospital of South Bend)H-Index: 8
#2Chun-Hsien Chen (Memorial Hospital of South Bend)H-Index: 3
Last. Jang-Jih Lu (Memorial Hospital of South Bend)H-Index: 18
view all 9 authors...
Background: Tumor markers are used to screen tens of millions of individuals worldwide at annual health check-ups, especially in East Asia. Machine learning (ML)-based algorithms that improve the diagnostic accuracy and clinical utility of these tests can have substantial impact leading to the early diagnosis of cancer. Methods: ML-based algorithms, including a cancer screening algorithm and a secondary organ of origin algorithm, were developed and validated using a large real world dataset (RWD...
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#1Valeria Panebianco (Policlinico Umberto I)H-Index: 25
#2Martina Pecoraro (Policlinico Umberto I)H-Index: 2
Last. Carlo Catalano (Policlinico Umberto I)H-Index: 46
view all 6 authors...
Up to date, screening for prostate cancer (PCa) remains one of the most appealing but also a very controversial topics in the urological community. PCa is the second most common cancer in men worldwide and it is universally acknowledged as a complex disease, with a multi-factorial etiology. The pathway of PCa diagnosis has changed dramatically in the last few years, with the multiparametric magnetic resonance (mpMRI) playing a starring role with the introduction of the “MRI Pathway”. In this sce...
3 CitationsSource
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...
Source
The role of biomarkers is crucial in oncology for both early diagnosis and the personalization of cancer treatments. Tissue biomarkers have gained a central role as predictors of the response to an...
Source
#1Rebecca LandyH-Index: 12
#2Lauren C. Houghton (Columbia University)H-Index: 5
Last. Amanda BlackH-Index: 18
view all 6 authors...
Longer-than-annual screening intervals have been suggested to improve the balance of benefits and harms in prostate cancer screening. Many researchers, societies and guideline committees have suggested that screening intervals could depend on the prostate specific antigen (PSA) result. We analyzed data from men (N=33,897) aged 55-74yrs with a baseline PSA test in the intervention arm of the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening trial (USA, 1993-2001). We estimated 5- and...
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#1Yi-Wei Xu (STU: Shantou University)H-Index: 6
#2Hao Chen (SYSU: Sun Yat-sen University)H-Index: 6
Last. En-Min Li (STU: Shantou University)H-Index: 22
view all 16 authors...
Abstract Background Early detection would improve upper gastrointestinal cancer prognosis. We aimed to identify serum protein biomarker for the detection of early-stage upper gastrointestinal cancer. Methods We performed a three-tiered study including 2028 participants from three medical centres. First, we applied two different antibody arrays to screen candidate serum proteins that increased in 20 patients with oesophageal squamous cell carcinoma (ESCC) compared with 20 normal controls. We then...
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Last. Shib D. Banerjee (Tufts University)H-Index: 8
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Objective Management and diagnosis of multiple human cancers remains a challenge and search for a common biomarker is still debatable. In this manuscript we have evaluated the use of monoclonal antibody UNIVmAb, to detect the protein (H11) as a common biomarker for all cancers irrespective of the grade and origin. We have shown by both ELISA and Western Blot that the H11 protein, is a unique hyaluronan binding protein that has not been detected earlier. H11 protein was fractionated in an anion e...
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#1Amandeep R. Mahal (Yale University)H-Index: 3
#2Santino Butler (Brigham and Women's Hospital)H-Index: 2
Last. Brandon A. Mahal (Brigham and Women's Hospital)H-Index: 18
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BACKGROUND: Management for men aged ≤55 years with low-risk prostate cancer (LRPC) is debated given quality-of-life implications with definitive treatment versus the potential missed opportunity for cure with conservative management. The objective of this study was to define rates of conservative management for LRPC and associated short-term outcomes in young versus older men in the United States. METHODS: The nonpublic Surveillance, Epidemiology, and End Results Prostate with Active Surveillanc...
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BACKGROUND: Liquid biopsies based on blood samples have been widely accepted as a diagnostic and monitoring tool for cancers, but extremely high sensitivity is frequently needed due to the very low levels of the specially selected DNA, RNA, or protein biomarkers that are released into blood. However, routine blood indices tests are frequently ordered by physicians, as they are easy to perform and are cost effective. In addition, machine learning is broadly accepted for its ability to decipher co...
1 CitationsSource
#1Fiona M Walter (University of Cambridge)H-Index: 34
#2Matthew Thompson (UW: University of Washington)H-Index: 32
Last. Jon Emery (University of Melbourne)H-Index: 42
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Background Novel diagnostic triage and testing strategies to support early detection of cancer could improve clinical outcomes. Most apparently promising diagnostic tests ultimately fail because of inadequate performance in real-world, low prevalence populations such as primary care or general community populations. They should therefore be systematically evaluated before implementation to determine whether they lead to earlier detection, are cost-effective, and improve patient safety and qualit...
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