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Prostate-specific antigen (PSA) update

The current issue of the BMJ reports the recommendations of the US Preventive Services Task Force, an independent body of 16 experts. They say that the PSA test should not be used to screen men for prostate cancer because it is unlikely to save lives and can cause harm.

The widespread US practice of annual PSA-based screening for prostate cancer in men aged 50 years and older is not supported by results from randomized controlled trials. PSA-based screening may modestly reduce prostate cancer mortality; this absolute benefit is small relative to other causes of death in this age group and is associated with substantial harms.


The potential harms from unnecessary investigations and treament include erectile xysfunction, urinary incontinence, bowel dysfunction, and death.

What is particularly interesting about this report is the delay that attended its publication. The group had made its recommendations in 2009 and 2010, but not until an article appeared in the New York Times were they made public, nearly two years after they were made. I wonder why.

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