2012 EDUCATIONAL BOOK - American Society of Clinical Oncology

Conclusion
One could argue that neither ERSPC nor PLCO findings
can be considered definitive, as the shortcomings of those
trials provide an unreliable measure of PSA’s actual benefit.
In fact, the Physician Data Query Prevention and Screening
Editorial Board concluded that the evidence for PSA screening
is insufficient to determine whether that practice results
in a mortality reduction. But board members concluded as
well that “based on solid evidence, screening with PSA
and/or digital rectal exam detects some prostate cancers
that would never have caused important clinical problems
and leads to some degree of overtreatment,” and that “based
on solid evidence, current prostate cancer treatments, in-
Authors’ Disclosures of Potential Conflicts of Interest
Author
Pamela M. Marcus*
Barnett S. Kramer*
*No relevant relationships to disclose.
Employment or
Leadership
Positions
Consultant or
Advisory Role
1. Chou R, Croswell JM, Dana T, et al. Screening for prostate cancer: a
review of the evidence for the U.S. Preventive Services Task Force. Ann Intern
Med. 2011;155:762-771.
2. Prorok PC, Kramer BS, Gohagan JK. Screening theory and study design:
the basics. In Kramer BS, Gohagan JK, Prorok PC (eds). Cancer Screening:
Theory and Practice. New York: Marcel Dekker, 1999;29-53.
3. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer
J Clin. 2012;62:10-29. Epub 2012 Jan 4.
4. Howlader N, Noone AM, Krapcho M, et al. (eds). SEER Cancer Statistics
Review 1975-2008. http://seer.cancer.gov/csr/1975_2008/. Accessed January
30, 2012.
5. UK National Screening Committee. Programme Appraisal Criteria.
http://www.screening.nhs.uk/criteria/fileid9287. Accessed January 30, 2012.
6. Djulbegovic M, Beyth RJ, Neuberger MM, et al. Screening for prostate
cancer: systematic review and meta-analysis of randomised controlled trials.
BMJ. 2010 Sep 14;341:c4543.
7. Schröder FH, Hugosson J, Roobol MJ, et al. Screening and prostatecancer
mortality in a randomized European study. N Engl J Med. 2009;360:
1320-1328.
8. Andriole GL, Crawford ED, Grubb RL 3rd, et al. Prostate cancer
screening in the randomized Prostate, Lung, Colorectal, and Ovarian Cancer
Screening Trial: Mortality results after 13 years of follow-up. J Natl Cancer
Inst. 2012;104:125-132.
9. Croswell JM, Kramer BS, Kreimer AR, et al. Cumulative incidence of
false-positive results in repeated, multimodal cancer screening. Am Fam Med.
2009;7:212-222.
10. Ilic D, O’Connor D, Green S, et al. Screening for prostate cancer.
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data from SEER-Medicare. J Urol. 2011;186:1830-1834. Epub 2011 Sep 23.
100
cluding radical prostatectomy and radiation therapy, result
in permanent side effects in many men.” 19
The harms associated with PSA screening for prostate
cancer are well-established; the benefit of screening, however,
is not and therefore remains theoretical. Given that a
central principle of medicine is “first, do no harm,” the
medical community must recognize that routine PSA screening
may run counter to that principle. Rather than simply
advocating the practice both in the office and in the public
arena, health care providers must engage in informed decision
making with men, as the U.S. Centers for Disease
Control and Prevention currently supports, 20 to make sure
they are aware of the potential benefits, harms, and remaining
uncertainties.
Stock
Ownership Honoraria
REFERENCES
Research
Funding
Expert
Testimony
MARCUS AND KRAMER
Other
Remuneration
12. Welch HG. Should I be tested for cancer? Maybe not and here’s why.
Berkeley and Los Angeles, CA, University of California Press, 2004.
13. Nam RK, Saskin R, Lee Y, et al. Increasing hospital admission rates for
urological complications after transrectal ultrasound guided prostate biopsy.
J Urol. 2010;183:963-969.
14. Penson DF, McLerran D, Feng Z, et al. 5-year urinary and sexual
outcomes after radical prostatectomy: results from the Prostate Cancer
Outcomes Study. J Urol. 2005;173:1701-1705.
15. Potosky AL, Davis WW, Hoffman RM, et al. Five-year outcomes after
prostatectomy or radiotherapy for prostate cancer: the Prostate Cancer
Outcomes Study. J Natl Cancer Inst. 2004;96:1358-1367.
16. Lu-Yao G, Albertsen PC, Stanford JL, Stukel TA, Walter-Corkery E,
Barry MJ. Screening, treatment, and prostate cancer mortality in the Seattle
area and Connecticut: fifteen-year follow-up. J Gen Intern Med. 2008;23:1809-
1814.
17. Draisma G, Boer R, Otto SJ, et al. Lead times and overdetection due to
prostate-specific antigen screening: estimates from the European Randomized
Study of Screening for Prostate Cancer. J Natl Cancer Inst. 2003;95:868-
878.
18. Draisma G, Etzioni R, Tsodikov A, et al. Lead time and overdiagnosis in
Prostate-Specific Antigen screening: importance of methods and context.
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19. Department of Health and Human Services, National Institutes of
Health, National Cancer Institute. Prostate cancer screening. http://www.
cancer.gov/cancertopics/pdq/screening/prostate/HealthProfessional. Accessed
March 5, 2012.
20. Department of Health and Human Services, Centers for Disease
Control and Prevention. Prostate cancer screening: a decision guide. http://
www.cdc.gov/cancer/prostate/pdf/prosguide.pdf. Accessed March 5, 2012.