Our review of the published work is built on previous systematic reviews of prostate cancer screening, supplemented by an update of subsequent research from reviews and bibliographies of published articles and publications identified from major bibliographic sources, including Medline, Embase, and Web of Science, focusing on issues relating to MeSH terms “prostatic neoplasms” and “mass screening”, and text terms “prostate cancer” and “screening”.
SeriesScreening for prostate cancer
Section snippets
Judging the merits of screening
Discussions of screening are conventionally based on the criteria described by Wilson and Jungner.7 The enduring authority of that 1968 account partly reflects the value of its contents, but also the lack of fresh thinking since that time. This area of health policy is unsatisfactory in that support for, or dismissal of, the worth of screening programmes is dominated by advocacy rather than scientific debate. The recurrent confusion in screening policy relates to three aspects of the Wilson and
Epidemiology and natural history
The epidemiology of prostate cancer has been discussed by Henrik Grönberg earlier in this Lancet series.9 Here, we focus on those issues most relevant to screening: the importance of the disorder, the potential for primary prevention, and the extent to which the natural history of prostate cancer renders it amenable to screening.
Effectiveness of screening programmes
In the USA, the reported incidence and mortality of prostate cancer have risen and then fallen49 in ways that have been attributed to PSA screening and treatment changes.50, 51, 52 Similar trends have been seen in Austria.53, 54 In Quebec City, Canada, a 67% reduction in deaths was attributed to screening.55 How strong are these data in suggesting that screening affects mortality? Some of the assertions of effectiveness are naive. For example the findings of the Quebec trial55 are probably the
Conclusions
The balance of proof must be high to justify exposing men older than 50 years to a process where, of 1 million men, about 110 000 with raised PSAs will face anxiety over possible cancer, about 90 000 will undergo biopsy, and 20 000 will be diagnosed with cancer. If 10 000 of these men underwent surgery, about ten would die of the operation, 300 will develop severe urinary incontinence, and even in the best hands 4000 will become impotent. The number of men whose prostate cancer would have
Search strategy and selection criteria
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