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Prostate cancer: to screen or not?

It seems that doctors in the USA often routinely send blood samples of middle-aged men for PSA (prostate-specific antigen) testing without even necessarily asking the patient first. This seems to me indefensible, given the uncertainty that exists about what treatment, if any to offer for screen-detected prostate cancer. This reflects a greater enthusiasm for screening in general in the USA.

A paper in the current issue of The British Journal of Cancer looks at this question.. This is is a technical paper with a lot of statistical information. But the authors’ conclusions are interesting.

The decision whether or not to have radical treatment is a value judgement, comparing the known morbidity of treatment with the potential survival benefit. Faced with a 30-60% risk of treatment-related impotence, and a 0-1% 15-year survival benefit, the majority of patients would decline radical treatment.

Patients and their clinicians, the authors suggest, may have unrealistically high expectations of the survival benefit of surgery in low-risk disease.

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