Screening for Prostate Cancer

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Abstract
Recently, increasing attention has focused on screening asymptomatic men for prostate cancer. Factors driving this initiative include the low percentage of localized cancers diagnosed by conventional methods, the inability to cure advanced disease, and the development of serum prostate-specific antigen (PSA) assay, which improves early detection. Unlike screening for breast cancer, however, no controlled studies have demonstrated that screening for prostate cancer reduces mortality or increases life expectancy. Until the National Institutes of Health—sponsored randomized screening trial is completed, some guidance is needed in making decisions regarding routine testing. See also p 773. The article by Krahn et al1in this issue ofThe JOURNALis the first study published using a Markov model to predict the outcomes from screening using PSA. Performing a one-time screen using digital rectal examination and PSA is predicted to increase life expectancy by 0.6 and 1.7 days for 50-and 70-year-old men, respectively. However,

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