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Evidence of Benefit

Summary of First Four Prostate, Lung, Colorectal, and Ovarian Screening Roundsa continued...

Decision analyses using the Markov model yield variable treatment outcomes because of the uncertainty regarding metastatic rates expected for prostate cancer and uncertainty about treatment efficacy.[103,104,105] A review of 59,876 men with prostate cancer diagnosed between 1983 and 1992 and registered by the SEER registries, however, shows that treatment of men with poorly differentiated and moderately differentiated disease is associated with an improved survival rate, compared with observation.[106] It is not known to what degree this can be attributed to treatment effect as opposed to other factors such as a preponderance of relatively healthy patients in the treated group. The information from Swedish studies of expectant therapy lead to different conclusions depending on methodology and populations used in analysis.[107]

Simulation modeling from the National Cancer Institute's CISNET program suggests that changes in prostate cancer treatment explain a portion of the drop in prostate cancer mortality but that most of the decline is likely the result of other factors such as screening or improvements in disease management after primary therapy.[108]

A simulation model based on available evidence suggests that if there is a benefit to screening, this benefit decreases with age.[109] No trial of prostate cancer screening in which the intervention arms were analyzed as randomized (analogous to an intention-to-treat analysis in a treatment trial) has been reported. There is insufficient evidence on which to decide the efficacy of TRUS and serum tumor markers (including PSA) for routine screening in asymptomatic men.[103,110]

Providing Information to the Public, to Patients, and to Their Families

While awaiting results of current studies, physicians and men (and their partners) are faced with the dilemma of whether to recommend or request a screening test. A qualitative study undertaken on focus groups of men, physician experts, and couples with screened and unscreened men has explored what information may help to inform a man undertaking a decision regarding PSA screening.[111] At a minimum, men should be informed about the possibility that false-positive or false-negative test results can occur, that it is not known whether regular screening will reduce the number of deaths from prostate cancer, and that among experts, the recommendation to screen is controversial. The PLCO-1, which is now closed to accrual, is following participants to test the effect of early detection by DRE and PSA on reducing mortality. A trial of screening is also being performed in Europe.[88,112]


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Last Updated: February 25, 2014
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