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Prostate cancer (again)

The current issue of The New England Journal of Medicine has several articles about PSA screening for prostate cancer. There is a lot of ill-informed advocacy in the media, including the BBC, to try to get everyone to take this test. But the balance of benefit against harm is still unclear, as an editorial in the journal makes clear after reviewing the results of two large surveys in the USA and Europe.

After digesting these reports, where do we stand regarding the PSA controversy? Serial PSA screening has at best a modest effect on prostate-cancer mortality during the first decade of follow-up. This benefit comes at the cost of substantial overdiagnosis and overtreatment. It is important to remember that the key question is not whether PSA screening is effective but whether it does more good than harm. For this reason, comparisons of the ERSPC estimates of the effectiveness of PSA screening with, for example, the similarly modest effectiveness of breast-cancer screening cannot be made without simultaneously appreciating the much higher risks of overdiagnosis and overtreatment associated with PSA screening.

The article concludes that it is more appropriate than ever for decisions about screening in individual cases to be made on the basis of discussion, not blanket recommendation.

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