John Concato, M.D., M.P.H., from the Veterans Affairs (VA) Connecticut Healthcare System, West Haven, and Yale University, New Haven, and colleagues conducted a study to address the question of whether screening improves the chances of survival. From approximately 72,000 veterans receiving health care at any of 10 VA medical centers in New England, they identified 501 men age 50 years and older who were diagnosed with prostate cancer between 1991 and 1995 and had died by the end of 1999. A comparison group of 501 living men was also identified; each man in this control group was matched, for age and treatment at the same center, to a man with prostate cancer who had died. Medical records were reviewed to determine whether men in either group had been screened for prostate cancer.

Seventy--or 14 percent--of the men who died of prostate cancer and 65 (13 percent) of the men in the control group were screened with PSA. If prostate cancer screening prevented death, fewer men who died would have received screening compared to the men who were living, the authors report. In addition, screening was not found to reduce mortality among men who were younger or healthier or when digital rectal exams were also considered. According to the authors, screening tests can increase the detection of cancer, even at earlier stages, but not necessarily prolong survival.

"Optimal clinical strategies for diagnosing and treating prostate cancer remain uncertain and in need of additional investigation," they write. "Based on available evidence, including the present study, recommendations regarding screening for prostate cancer should not endorse routine testing of asymptomatic men to reduce mortality. Rather, the uncertainty of screening should be explained to patients in a process of 'verbal informed consent,' promoting informed decision making."