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Controversies in Internal Medicine |

An Argument Against Routine Prostate Cancer Screening

Richard M. Hoffman, MD, MPH
Arch Intern Med. 2003;163(6):663-665. doi:10.1001/archinte.163.6.663.
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PRIMARY CARE physicians should not be routinely screening for prostate cancer. There is no conclusive evidence that screening is effective in reducing prostate cancer morbidity and mortality, but there is considerable evidence that screening and treatment can be harmful. Primary care physicians should routinely discuss screening, but patients need to make an informed decision to be screened.

Prostate cancer is an important public health problem—a devastating disease that was expected to have killed more than 30 000 American men in 2002.1 Unfortunately, our current prevention and treatment strategies are limited in their ability to reduce the burden of suffering from prostate cancer. The strongest risk factors are age, race, and family history, none of which can be modified. Although dietary micronutrients, antioxidant vitamins, and finasteride are being studied for the primary prevention of prostate cancer, we currently have no proven prevention strategy. Men with advanced cancers can be treated only with palliative therapy. Consequently, there has been great interest in detecting prostate cancers at an early, asymptomatic stage, especially since the discovery of PSA. The hope is that detecting early stage cancers and treating them aggressively with surgery or radiation will reduce morbidity and mortality from prostate cancer. The American Urologic Association2 and the American Cancer Society3 support routine screening for prostate cancer using PSA and DRE. However, other professional organizations, such as the American College of Physicians–American Society of Internal Medicine4 and the US Preventive Services Task Force5 recommend against routine screening.

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