What Do the Screening Trials Really Tell Us and Where Do We Go From Here?

Publication of apparently conflicting results from 2 large trials of prostate cancer screening has intensified the debate about prostate-specific antigen (PSA) testing and has led to a recommendation against screening from the US Preventive Services Task Force. This article reviews the trials and discusses the limitations of their empirical results in informing public health policy. In particular, the authors explain why harm-benefit trade-offs based on empirical results may not accurately reflect the trade-offs expected under long-term population screening. This information should be useful to clinicians in understanding the implications of these studies regarding the value of PSA screening.

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The balance of screening harm with benefit will be materially affected by patient decisions following diagnosis, such as whether the patient selects aggressive curative treatment or active surveillance to reduce the chance of overtreatment.

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