Brian Jackson on Prostate Cancer Screening

http://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2012-0241-ED

Brian R. Jackson (2013) Prostate-Specific Antigen, Prostate Cancer Screening, and the Pathologist: What Should Be Our Role?. Archives of Pathology & Laboratory Medicine: March 2013, Vol. 137, No. 3, pp. 308-309.

EDITORIALS

Prostate-Specific Antigen, Prostate Cancer Screening, and the Pathologist: What Should Be Our Role?

Brian R. Jackson , MD, MS

From the Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City.

Most readers will be familiar with the following background: Since the introduction of the PSA test in the 1970s, it has become one of the most popular preventive care tests in the country. Yet the evidence for reduced mortality attributable to PSA screening is, at best, weak. Two recently published, large, randomized studies reported conflicting results. The European Randomized Study of Screening for Prostate Cancer¹ found a modest reduction in mortality with screening; the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial² did not.

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Accordingly, guideline development organizations, notably including the American Cancer Society and the American Urologic Association, have issued expert opinions recommending that prostate cancer screening should only be entertained in men who might reasonably stand to benefit and who are in a position to make a fully informed choice that incorporates their personal risk/benefit profile with their personal values. These appear on the surface to be very reasonable recommendations, but, in fact, they reflect an almost impossible aspiration in today's health care environment.