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The effectiveness of screening for prostate cancer: a nested case-control study.
John Concato1, Carolyn K Wells, Ralph I Horwitz
1Clinical Epidemiology Research Center and Cooperative Studies Program Coordinating Center, Department of Veterans Affairs Connecticut Healthcare System, West Haven Veterans Affairs Medical Center 06516, USA. john.concato@yale.edu
Archives of Internal Medicine
|January 13, 2006
Summary
Prostate cancer screening using PSA tests or DRE did not show a survival benefit in this study. Further research is needed to confirm if these screening methods reduce mortality effectively.
Area of Science:
- Urology
- Oncology
- Public Health
Background:
- Prostate cancer screening is common using prostate-specific antigen (PSA) tests and digital rectal examination (DRE).
- Evidence supporting a survival benefit from prostate cancer screening remains limited.
- This study evaluated the effectiveness of PSA, with or without DRE, in reducing prostate cancer mortality.
Purpose of the Study:
- To assess the impact of PSA screening on all-cause mortality.
- To determine if PSA and/or DRE screening reduces prostate cancer-specific mortality.
- To provide evidence-based recommendations for prostate cancer screening practices.
Main Methods:
- A multicenter nested case-control study was conducted involving 71,661 patients.
- 501 case patients diagnosed with prostate cancer and who died were matched with control patients.
- Screening exposure (PSA and/or DRE) was assessed blindly to case-control status and adjusted for covariates.
Main Results:
- PSA screening did not demonstrate a significant reduction in all-cause mortality (aOR, 1.08; P=.72).
- PSA and/or DRE screening did not significantly reduce prostate cancer-specific mortality (aOR, 1.13; P=.68).
- No statistically significant benefit of screening was found in the primary or secondary analyses.
Conclusions:
- Current evidence does not support the effectiveness of PSA or DRE screening in reducing prostate cancer mortality.
- The findings underscore the importance of informed consent discussions regarding prostate cancer screening.
- Continued emphasis on verbal informed consent for PSA and DRE screening is recommended.