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Contempo 1998
July 8, 1998

Detection of Prostate and Colon Cancer

Author Affiliations

From the Department of Medicine, University of Chicago, Chicago, Ill.


Edited by Ronna Henry Siegel, MD, Contributing Editor.

JAMA. 1998;280(2):117-118. doi:10.1001/jama.280.2.117

CANCER DETECTION continues to be an important focus of primary care. Many groups, including the American Cancer Society and the US Preventive Services Task Force, periodically publish recommendations for cancer screening. As new information becomes available, these recommendations need reevaluation and revision. In this article, we review recent studies that have modified our approach to the detection of prostate cancer and colorectal cancer.

Screening for prostate cancer by serum prostate-specific antigen (PSA) measurement continues to generate controversy. PSA testing is recommended by the American Cancer Society1 but not by the US Preventive Services Task Force.2 Critics of PSA screening raise several concerns. First, there have been no randomized trials showing that the detection of prostate cancer by PSA screening decreases prostate cancer–associated morbidity or mortality. Second, autopsy studies suggest that 30% of men have indolent tumors that develop late in life and often do not affect survival.2 Third, PSA testing has a high false-positive rate: in 1 study,3 78% of men with PSA levels of 4 to 10 ng/mL did not have prostate cancer on prostate biopsy specimens. In addition, combined digital rectal examination (DRE) and PSA screening may lead to prostate biopsies for 15% to 40% of tested men.4 Finally, prostate cancer therapy is associated with significant morbidity: radical prostatectomy has an estimated 30-day mortality rate of 0.5%, a 30% risk of incontinence, and a 20% to 85% risk of erectile dysfunction.4 Complications of radiotherapy include gastrointestinal and genitourinary problems (8%-43%), erectile dysfunction (40%-67%), incontinence (1%-2%), and death (0.2%-0.5%).2

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