Editorials

PSA screening for prostate cancer

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g2559 (Published 15 April 2014) Cite this as: BMJ 2014;348:g2559
  1. Timothy J Wilt, professor of medicine and core investigator1,
  2. Philipp Dahm, professor of urology and residency programme director2
  1. 1Minneapolis Veterans Affairs Health Care System, General Internal Medicine and the Center for Chronic Disease Outcomes Research, 1 Veterans Drive (111-0), Minneapolis, MN 55417, USA, and Department of Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA
  2. 2Malcom Randall VA Medical Center, and Department of Urology, University of Florida, College of Medicine, Gainesville, FL, USA
  1. Correspondence to: T J Wilt tim.wilt{at}va.gov

Achieve more for patients and payers by doing less

Few healthcare issues have generated as much controversy as prostate specific antigen (PSA) based screening for prostate cancer.1 2 Enthusiasm for such screening is high in part because a seemingly simple blood test can lead to early detection and treatment of a common and potentially lethal disease. Screening has resulted in a noticeable increase in incidence of prostate cancer and near universal active treatment for screen detected disease. However, recent science shows that screening for prostate cancer, as with all screening strategies, is a complex process and double-edged sword. This provides the background for the linked paper by Carlsson and colleagues (doi:10.1136/bmj.g2296).3 Though some men may benefit from screening, many more are harmed by testing and the cascade of diagnostic and treatment related events that follow. Further, men and society bear the financial costs of this screening cascade.

Rising healthcare costs and evidence that a large portion of healthcare is ineffective, unnecessary, costly, and potentially harmful require a re-evaluation of how better healthcare can be provided at lower costs—that is, how value can be improved. Screening strategies that yield similar benefits with fewer harms or lower costs provide better value; strategies that produce no benefit or where benefits do not justify harms or costs provide poor value. The value of effective screening tests can be modified by “screening intensity”—that is, by adjusting the population screened, the frequency of screening, or the …

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