Prostate Cancer Screening: Time to Question How to Optimize the Ratio of Benefits and Harms
Authors: Andrew J. Vickers
Journal: Annals of Internal Medicine (2017)

Editorials3 October 2017Prostate Cancer Screening: Time to Question How to Optimize the Ratio of Benefits and HarmsAndrew J. Vickers, PhDAndrew J. Vickers, PhDFrom Memorial Sloan Kettering Cancer Center, New York, New York.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Screening for prostate cancer with prostate-specific antigen (PSA) testing has been widespread in the United States since the late 1980s. Remarkably, it was not until 2009 that good evidence was published on the effectiveness of PSA screening, when the results of the PLCO (Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial) and the ERSPC (European Randomized Study of Screening for Prostate Cancer) appeared together in the New England Journal of Medicine (1, 2). Their findings seemed contradictory: The PLCO found low rates of prostate cancer death that did not differ significantly between groups (1), whereas the ERSPC suggested that screening ...References1. Andriole GL, Crawford ED, Grubb RL, Buys SS, Chia D, Church TR, et al; PLCO Project Team. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360:1310-9. [PMID: 19297565] doi:10.1056/NEJMoa0810696 CrossrefMedlineGoogle Scholar2. Schröder FH, Hugosson J, Roobol MJ, Tammela TL, Ciatto S, Nelen V, et al; ERSPC Investigators. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360:1320-8. [PMID: 19297566] doi:10.1056/NEJMoa0810084 CrossrefMedlineGoogle Scholar3. Barry MJ. Screening for prostate cancer—the controversy that refuses to die [Editorial]. N Engl J Med. 2009;360:1351-4. [PMID: 19297564] doi:10.1056/NEJMe0901166 CrossrefMedlineGoogle Scholar4. Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. Cochrane Database Syst Rev. 2013:CD004720. [PMID: 23440794] doi:10.1002/14651858.CD004720.pub3 CrossrefMedlineGoogle Scholar5. Moyer VA; U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157:120-34. [PMID: 22801674]. doi:10.7326/0003-4819-157-2-201207170-00459 LinkGoogle Scholar6. Shoag JE, Mittal S, Hu JC. Reevaluating PSA testing rates in the PLCO trial [Letter]. N Engl J Med. 2016;374:1795-6. [PMID: 27144870] doi:10.1056/NEJMc1515131 CrossrefMedlineGoogle Scholar7. Tsodikov A, Gulati R, Heijnsdijk EAM, Pinsky PF, Moss SM, Qiu S, et al. Reconciling the effects of screening on prostate cancer mortality in the ERSPC and PLCO trials. Ann Intern Med. 2017;167:449-55. doi:10.7326/M16-2586 LinkGoogle Scholar8. Vickers AJ, Edwards K, Cooperberg MR, Mushlin AI. A simple schema for informed decision making about prostate cancer screening. Ann Intern Med. 2014;161:441-2. [PMID: 25222389]. doi:10.7326/M14-0151 LinkGoogle Scholar9. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer Early Detection. Version 1. 2016. Google Scholar10. Carlsson SV, de Carvalho TM, Roobol MJ, Hugosson J, Auvinen A, Kwiatkowski M, et al. Estimating the harms and benefits of prostate cancer screening as used in common practice versus recommended good practice: a microsimulation screening analysis. Cancer. 2016;122:3386-93. [PMID: 27459245] doi:10.1002/cncr.30192 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Memorial Sloan Kettering Cancer Center, New York, New York.Financial Support: In part by funds from the Sidney Kimmel Center for Prostate and Urologic Cancers, a Specialized Programs of Research Excellence grant (P50-CA92629) from the National Cancer Institute to Dr. Howard Scher, and a National Institutes of Health/National Cancer Institute Cancer Center Support Grant (P30-CA008748) to Memorial Sloan Kettering Cancer Center.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2012.Corresponding Author: Andrew J. Vickers, PhD, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, 2nd Floor, New York, NY 10065; e-mail, [email protected]org.This article was published at Annals.org on 5 September 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoReconciling the Effects of Screening on Prostate Cancer Mortality in the ERSPC and PLCO Trials Alex Tsodikov , Roman Gulati , Eveline A.M. Heijnsdijk , Paul F. Pinsky , Sue M. Moss , Sheng Qiu , Tiago M. de Carvalho , Jonas Hugosson , Christine D. Berg , Anssi Auvinen , Gerald L. Andriole , Monique J. Roobol , E. David Crawford , Vera Nelen , Maciej Kwiatkowski , Marco Zappa , Marcos Luján , Arnauld Villers , Eric J. Feuer , Harry J. de Koning , Angela B. Mariotto , and Ruth Etzioni Metrics Cited byDiagnostic role of plasma ORM2 in differentiating prostate cancer from benign prostatic hyperplasiaTwo-year profile of the records of patients referred to Adana city hospital urology clinic due to PSA high in primary care: a retrospective reviewAssociation between Serum Triglycerides and Prostate Specific Antigen (PSA) among U.S. Males: National Health and Nutrition Examination Survey (NHANES), 2003–2010The Prognostic Value of Plasma Cell-Free DNA Concentration in the Prostate Cancer: A Systematic Review and Meta-AnalysisAssociation of Total Dietary Intake of Sugars with Prostate-Specific Antigen (PSA) Concentrations: Evidence from the National Health and Nutrition Examination Survey (NHANES), 2003-2010Association of schistosomiasis and risk of prostate cancer development in residents of Murehwa rural community, ZimbabweScreening TestsOptimal Starting Age and Baseline Level for Repeat Tests: Economic Concerns of PSA Screening for Chinese Men – 10-Year Experience of a Single CenterHnRNPM is a potential mediator of YY1 which promotes EMT in prostate cancer cellsProstatakarzinomscreening mittels prostataspezifischem Antigen (PSA)Prostate Cancer ScreeningPrävention im Alter durch Risikovermeidung, Früherkennung und frühe BehandlungExnovation of Low Value Care: A Decade of Prostate-Specific Antigen Screening PracticesSobrediagnóstico por imagenControversies in PSA screening 3 October 2017Volume 167, Issue 7Page: 509-510KeywordsAntigensAspirinBiopsyCancer screeningDisclosureMortalityProstate cancerReflexesResearch grantsSurgeons ePublished: 5 September 2017 Issue Published: 3 October 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. 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