Prostate-specific antigen (PSA) screening has been controversial since its inception. Given the vast disparity in professional organization guidelines (from no screening to PSA testing starting at age 40 years), it is not surprising that practice patterns vary widely among internists and primary care providers. Until recently, evidence from randomized, controlled trials was lacking to assess whether PSA screening saves lives. In 2009, mortality data were published from the Prostate, Lung, Colorectal and Ovarian (PLCO) screening trial and the European Randomized Study of Screening for Prostate Cancer (ERSPC). The PLCO trial found no prostate cancer-specific mortality benefit from screening, although high levels of prescreening, contamination (screening of controls), and non-compliance with prompt biopsy likely account for these negative findings. By contrast, the ERSPC found a 41% decrease in metastatic disease and 20% cancer-specific mortality reduction with screening at a median follow-up of 9 years in their intent-to-treat analysis. Rather than clarifying the issue, however, these seemingly disparate findings have continued to perpetuate the controversy: to screen or not to screen?
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