Bad habits may be hard to break

摘要

Prostate-specific antigen (PSA)-based screening for prostate cancer (PCa) is likely here to stay. This conclusion seems inescapable, notwithstanding two large random prospective trials that show either no benefits (Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial [PLCO]) or fairly modest benefits (European Randomized Study of Screening for Prostate Cancer) for reducing PCa-specific mortality [1,2]. The inevitability of PSA testing is supported by other observations including the behavior of the control group of the PLCO [3] and "popular opinion," through which large segments of patients in the United States undergo frequent testing. This has been long recognized, and the age stratum most likely to be screened is the upper 70s [4]. Now the data from Nordstrom et al. [5] show a similar pattern emerging in Stockholm County, Sweden. These new data raise important questions: If PSA testing is inevitable, can it nonetheless be discouraged for the men who are least likely to benefit from it due to their age or comorbidity [6]? And can retesting be discouraged for men with very low initial PSA levels (eg, <1), namely, men who have a very low likelihood of future development of a clinically significant cancer [7,8]?