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September 10, 2014

Focusing PSA Testing on Detection of High-Risk Prostate Cancers by Incorporating Patient Preferences Into Decision Making

Author Affiliations
  • 1Department of Urology and Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio
  • 2Department of Epidemiology and Biostatistics, University of Texas Health Science Center at San Antonio
  • 3Department of Mathematics, Technical University Munich, Germany
JAMA. 2014;312(10):995-996. doi:10.1001/jama.2014.9680

In the mid-1980s, the discovery that prostate-specific antigen (PSA) testing, coupled with prostate biopsy, could identify silent prostate cancers that would otherwise be present as metastatic disease led to substantial increases in cancer detection and subsequent treatment. With time, more intensive screening and biopsy led to significant increases in detection of low-grade tumors that are almost ubiquitous at autopsy in older men. Although during the ensuing 2 decades there was a 44% decline in prostate cancer mortality (likely attributable, in part, to early detection with PSA testing), the effect of detection and treatment as well as the complications from treatment (erectile dysfunction, urinary obstruction or incontinence, and gastrointestinal adverse effects) led the US Preventive Services Task Force to recommend against PSA screening in the general population.1 Results from 2 large randomized clinical trials (RCTs) of PSA screening, in which a European RCT reported a modest reduction in prostate cancer mortality and a US trial found no change in mortality, reinforced this conclusion.2,3

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