Should we screen for prostate cancer?

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7086.989 (Published 05 April 1997) Cite this as: BMJ 1997;314:989

Men over 50 have a right to decide for themselves

  1. Steven H Woolf, Associate clinical professora
  1. a Department of Family Practice, Medical College of Virginia, Fairfax, VA 22033, USA (shwoolf@aol.com)

    Routine screening for any condition is unwarranted without evidence that the test accurately detects early disease, that early detection improves outcomes, and that benefits outweigh harms. Unfortunately, such evidence is lacking for prostate cancer.

    Although the test for prostate specific antigen (PSA) has reasonable sensitivity, it produces false positive results in two thirds of asymptomatic men.1 About a third of tumours detected by the test are localised and more likely to progress, but there is no good evidence that treatment improves outcomes.1 Moreover, the complications from screening and treatment may offset the potential benefits. Two recent reviews commissioned by the NHS Health Technology Assessment programme2 3 and a summary by the NHS Centre for Reviews and Dissemination4 came down against routine screening for prostate cancer and discouraged purchasers from paying for it. The reports instead encouraged further research to evaluate its effectiveness.

    Are these recommendations reasonable? The answer differs for populations and individuals. Deciding whether to screen a population requires an assessment of the benefits and harms to society. The average preferences of the population, rather than those of individuals, must be considered. Although some men might prefer to be screened, the interests of the …

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