Prostate-specific antigen (PSA) screening has been a disappointing public health strategy. The history of the PSA test will one day serve as a reminder that, although all of us in health care want to do everything possible to reduce the mortality of cancer, the early adoption of screening techniques on the basis of insufficient evidence can lead to more harm than good.
In this issue of JAMA Internal Medicine, Sammon and colleagues1 remind us that this day has not yet arrived. Contrary to the recommendations of the US Preventive Services Task Force (USPSTF) against routine screening, the use of prostate cancer screening continues at an alarming rate. More than one-third of men in America 80 years and older are screened, more than 40% of men aged 75 to 79 years, and nearly one-half of men between and 65 and 74 years.1 In addition, there is marked geographic variation in the rate of screening, with rates in Hawaii as high as 59.4% and in New Hampshire as low as 24.5%.1 These results suggest that patient preferences are unlikely to account for our patterns of use. Although some patients in the sample may have been screened just prior to current recommendations, many others likely underwent screening afterward.
Prasad V. It Is Time to Stop Screening for Prostate Cancer. JAMA Intern Med. 2014;174(11):1841-1842. doi:10.1001/jamainternmed.2014.3078