Current status of PSA screening. Early detection of prostate cancer.
OBJECTIVE
To update current evidence for prostate-specific antigen (PSA) screening for prostate cancer and to give readers some practical information to discuss with patients. QUALITY OF EVIDENCE A MEDLINE: search revealed only three randomized studies, two of which are incomplete. Several controlled non-randomized studies were found.


RESULTS
Two ongoing studies have not yet reported survival data, but have added to evidence for screening intervals. One Canadian randomized study has been criticized for its design and conclusions. Non-randomized studies suggest that screening effectively identifies serious cancers and leads to earlier diagnosis. Mortality from prostate cancer has been falling in most western countries since 1992. This cannot be explained by PSA screening, which would probably not produce survival benefit until at least 10 years after its unofficial introduction in about 1990.


CONCLUSIONS
Indirect evidence suggests that all men older than 45 with at least a 10-year life expectancy should be informed of the potential benefits and drawbacks of PSA screening so they can make an informed decision on whether to have the test.
Pickles
Tom
T
Genito-Urinary Tumour Group, British Columbia Cancer Agency, Vancouver.
D000368:Aged; D003937:Diagnosis, Differential; D019317:Evidence-Based Medicine; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010353:Patient Education as Topic; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000032:analysis*; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis
D017430:Prostate-Specific Antigen