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EDITORIAL HEALTH CARE REFORM Weighing the Benefits and Downsides of Prostate-Specific Antigen Screening ROSTATE CANCER IS COMMON (186 000 NEW tate cancer screening leads to a modest absolute reduc- US diagnoses in 2008), causing more than tion in prostate cancer mortality over time. However, this 28 000 deaths per year. Treatment of clini- benefit comes at a large cost in terms of increasing the cally detected prostate cancer is effective in diagnosis and treatment of cancers that would not have P reducing prostate cancer mortality in men gone on to cause any problems. Moreover, the harms of younger than 65 years but not in older men. However, screening begin to accrue immediately, whereas the po- treatment of prostate cancer is associated with consid- tential benefits are realized only many years later. erable morbidity; approximately 50% of men will have Given the current state of knowledge, physicians, pa- impotence, incontinence, or both after treatment, and a tients, and policymakers must attempt to integrate the few will die as a result of initial treatment. information on benefits and downsides to reach a deci- Screening with the prostate-specific antigen (PSA) sion about what to do. Guidelines from the US Preven- blood test
JAMA Internal Medicine – American Medical Association
Published: Sep 28, 2009
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