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."
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