Harvard Perspectives on Prostate Disease

The ongoing debate continues

A message from Editor in Chief Marc B. Garnick, M.D.

Despite little evidence of benefit, most men over age 50 have had a prostate-specific antigen (PSA) test. And since 1992, the prostate cancer mortality rate in the United States has fallen by about 4% a year. But can we credit the falling death rate to PSA screening? Or are other factors, such as better-targeted treatments, playing a part?

My colleagues and I thought two large randomized trials would finally settle the debate. But both trials published early findings in March 2009 that seemed to come to opposite conclusions: the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial reported no survival benefit with PSA screening and digital rectal examination, but the European Randomized Study of Screening for Prostate Cancer (ERSPC) found a 20% reduction in prostate cancer mortality. Confused men started asking their doctors, "Should I have a PSA test or not?"

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