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A sophisticated reading of the randomized trial evidence suggests that, although screening for prostate cancer with prostate-specific antigen (PSA) can reduce cancer-specific mortality, it does so at considerable cost in terms of the number of men who need to be screened, biopsied, and treated to prevent one death. The challenge is to design screening programs that maximize benefits (reducing prostate cancer mortality) and minimize costs (overtreatment). Recent research has suggested that this can be achieved by risk-stratifying screening and biopsy; increasing reliance on active surveillance for low-risk cancer; restricting radical prostatectomy to high-volume surgeons; and using appropriately high-dose radiotherapy. In current U.S. practice, however, many men who are screened are unlikely to benefit, most men found to have low-risk cancers are referred for unnecessary curative treatment, and much treatment is given at low-volume centers.

Original publication

DOI

10.1146/annurev-med-050710-134421

Type

Journal article

Journal

Annu Rev Med

Publication Date

2012

Volume

63

Pages

161 - 170

Keywords

Early Diagnosis, Humans, Male, Mass Screening, Prostatic Neoplasms, Risk Assessment, Risk Factors, Unnecessary Procedures