Prostate Cancer Screening and Surveillance—Reply
- Martin G. Sanda, MDDivision of Urology;
- Irving D. Kaplan, MDDepartment of Radiation OncologyBeth Israel Deaconess Medical CenterBoston, Massachusetts
Since this article does not have an abstract, we have provided the first 150 words of the full text.
- KEYWORDS:
- COST-BENEFIT ANALYSIS
- DATA INTERPRETATION, STATISTICAL
- DECISION MAKING
- EARLY DETECTION OF CANCER
- MASS SCREENING
- MORTALITY
- PROSTATE-SPECIFIC ANTIGEN
- PROSTATIC NEOPLASMS
In Reply: Dr Rogers raises notable caveats regarding the clinical significance attributable to PSA screening observed in the ERSPC trial: improved survival associated with PSA screening (and consequent justifiable treatment of aggressive cancers) appears to come at the expense of overdiagnosis and overtreatment of low-risk cancers that have a potentially indolent clinical course. We acknowledge these limitations of PSA screening—and the burden this uncertainty brings to discussions between physicians and patients—in efforts to decide whether a man should undergo a PSA blood test and, if so, at what age and how frequently. As well-described in the Editorial1 that accompanied the ERSPC and PLCO trials, these studies represent laudable efforts but nevertheless have limitations that preclude them from providing a final resolution to the conundrum that mortality reduction from PSA screening is accompanied by overtreatment.
Dilemmas regarding cost-effectiveness of PSA screening that cannot be resolved due to limitations of the …
