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Invited Commentary
July 26, 2010

The Cautionary Tale of PSA Testing: Comment on “Risk Profiles and Treatment Patterns Among Men Diagnosed as Having Prostate Cancer and a Prostate-Specific Antigen Level Below 4.0 ng/mL”

Author Affiliations

Author Affiliations: Medicine Service, New Mexico VA Health Care System, and University of New Mexico School of Medicine, Albuquerque (Dr Hoffman); Health Services Research & Development Center of Excellence, VA Puget Sound Health Care System, and Department of Health Services, University of Washington, Seattle (Dr Zeliadt).

Arch Intern Med. 2010;170(14):1262-1263. doi:10.1001/archinternmed.2010.222

The initial promise of PSA screening was that a simple, accurate blood test would save lives by detecting tumors at an early enough stage to be cured by aggressive treatment. Unfortunately, some 2 decades into the PSA era, the promise of early detection has been tarnished. In the United States, widespread PSA testing led to a higher incidence of early-stage disease, creating an epidemic of prostate cancer in which the lifetime risk of diagnosis increased from 9% to 16%.1 However, a substantial proportion of these PSA-detected cancers likely never would have been found in the absence of screening.2 Nevertheless, as Shao and colleagues highlight, even the lowest-risk tumors are often treated aggressively. These findings lead to the disconcerting realization that an important legacy of the PSA era might be the overdiagnosis and overtreatment of low-risk cancers. Herein, we address the potential harms from PSA testing and the implications for clinical practice.

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