Screening for prostate cancer: the roles of science, policy, and opinion in determining what is best for patients

Annu Rev Med. 1999;50:207-21. doi: 10.1146/annurev.med.50.1.207.

Abstract

Controversy over screening for prostate cancer involves both scientific and policy considerations. The principal scientific questions are whether tumors detected by screening are clinically significant, whether screening generates too many false-positive results, and whether early detection lowers morbidity or mortality. Both screening and treatment of prostate cancer can be harmful, making the tradeoff between benefits and risks especially relevant. Studies suggest that this judgment is highly personal, depending on the relative importance that individuals assign to potential outcomes. Opinions and policy considerations also influence views about the appropriateness of screening. Chief among these are personal beliefs about benefits and harms, medicolegal concerns, patient expectations, resource constraints, and opportunity costs. Appropriate policy must discriminate between what is best for populations and for individual patients. The lack of evidence of benefit and the potential harms argue against a societal policy of routine screening. Individual patients who could benefit from screening should be informed about the potential benefits and harms and invited to make a personal choice based on their priorities and concerns.

Publication types

  • Review

MeSH terms

  • Attitude to Health
  • Decision Making
  • False Positive Reactions
  • Forensic Medicine
  • Health Care Costs
  • Health Policy
  • Health Priorities
  • Health Resources
  • Humans
  • Male
  • Mass Screening* / adverse effects
  • Mass Screening* / economics
  • Mass Screening* / methods
  • Physician-Patient Relations
  • Prostatic Neoplasms / diagnosis*
  • Prostatic Neoplasms / therapy
  • Public Opinion*
  • Public Policy*
  • Risk Assessment
  • Science*
  • Treatment Outcome