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Screening for Prostate Cancer: An Update of the Evidence for the U.S. Preventive Services Task Force
- Russell Harris, MD, MPH; and
- Kathleen N. Lohr, PhD
- From University of North Carolina at Chapel Hill, Chapel Hill, and Research Triangle Institute, Research Triangle Park, North Carolina.
Abstract
Background: In U.S. men, prostate cancer is the most common noncutaneous cancer and the second leading cause of cancer death. Screening for prostate cancer is controversial.
Purpose: To examine for the U.S. Preventive Services Task Force the evidence of benefits and harms of screening and earlier treatment.
Data Sources: MEDLINE and the Cochrane Library, experts, and bibliographies of reviews.
Study Selection: Researchers developed eight questions representing a logical chain between screening and reduced mortality, along with eligibility criteria for admissible evidence for each question. Admissible evidence was obtained by searching the data sources.
Data Extraction: Two reviewers abstracted relevant information using standardized abstraction forms and graded article quality according to Task Force criteria.
Data Synthesis: No conclusive direct evidence shows that screening reduces prostate cancer mortality. Some screening tests can detect prostate cancer at an earlier stage than clinical detection. One study provides good evidence that radical prostatectomy reduces disease-specific mortality for men with localized prostate cancer detected clinically. No study has examined the additional benefit of earlier treatment after detection by screening. Men with a life expectancy of fewer than 10 years are unlikely to benefit from screening even under favorable assumptions. Each treatment is associated with several well-documented potential harms.
Conclusions: Although potential harms of screening for prostate cancer can be established, the presence or magnitude of potential benefits cannot. Therefore, the net benefit of screening cannot be determined.
Article and Author Information
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Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the U.S. Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
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Acknowledgments: The authors acknowledge the continuing support of David Atkins, MD, MPH, and the guidance and feedback of Cynthia D. Mulrow, MD, MPH, University of Texas at San Antonio, Paul S. Frame, MD, Cohocton, New York, and other members of the USPSTF. They thank the staff of the Research Triangle Institute–University of North Carolina Evidence-based Practice Center, including Audrina J. Bunton, BA, Linda Lux, MPA, and Sonya Sutton, BSPH, for substantive and editorial work and Loraine Monroe for secretarial assistance. They also thank Rainer Beck, MD, Paul Godley, MD, MPH, and Kenneth Fink, MD, MPH, for assistance in reviewing articles. In addition, they thank the staff from the University of North Carolina at Chapel Hill and the Cecil G. Sheps Center for Health Services Research, including Timothy S. Carey, MD, MPH, Anne Jackman, MSW, Lynn Whitener, MSLS, DrPH, and Carol Krasnov. They also thank the peer reviewers of the complete systematic evidence review: Michael Barry, MD, Medical Practices Evaluation Center, Boston, Massachusetts; John W. Feightner, MD, MSC, Canadian Task Force on Preventive Health Care, London, Ontario, Canada; Theodore Ganiats, MD, University of California at San Diego, La Jolla, California; Marc B. Garnick, MD, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Richard Hoffman, MD, MPH, Albuquerque Veterans Affairs Medical Center, Albuquerque, New Mexico; Barnett Kramer, MD, National Institutes of Health, Bethesda, Maryland; David Lush, MD, Medical College of Pennsylvania, Philadelphia, Pennsylvania; Curtis Mettlin, MD, Roswell Park Cancer Institute, Buffalo, New York; and Ian M. Thompson Jr., MD, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas.
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Grant Support: This study was conducted by the Research Triangle Institute–University of North Carolina Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality, Rockville, Maryland (contract no. 290-97-0011, task order 3).
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Requests for Single Reprints: Reprints are available from the Agency for Healthcare Research and Quality Web site (http://www.ahrq.gov/clinic/uspstffix.htm) or the Agency for Healthcare Research and Quality Publications Clearinghouse.
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Current Author Addresses: Dr. Harris: Cecil G. Sheps Center for Health Services Research, CB# 7590, University of North Carolina School of Medicine, 725 Airport Road, Chapel Hill, NC 27599-7590.
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Dr. Lohr: Research Triangle Institute, PO Box 12194, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194.
- Copyright ©2004 by the American College of Physicians
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