Prostate cancer screening: what we know and what we need to know

Ann Intern Med. 1993 Nov 1;119(9):914-23. doi: 10.7326/0003-4819-119-9-199311010-00009.


Objective: To critically evaluate the evidence for recommending the screening of asymptomatic men for prostate cancer with a blood test to detect a prostate-specific antigen (PSA).

Data sources: Relevant articles on screening for prostate cancer were identified from MEDLINE searches, from the authors' files, and from the bibliographies of identified articles.

Study selection: In the absence of controlled prospective trials, the studies are primarily retrospective and contain information about the sensitivity, specificity, and predictive values of tests used to screen for prostate cancer; the natural history of untreated prostate cancer; the morbidity, mortality, and costs of definitive treatment; and reviews of screening study biases.

Data extraction: Potential treatment-related mortality and costs that could be incurred by screening were estimated using defined assumptions.

Results: Although screening for prostate cancer has the potential to save lives, because of possible overdiagnosis, screening and subsequent therapy could actually have a net unfavorable effect on mortality or quality of life or both. Given the performance characteristics of the test, widespread screening efforts would probably cost billions of dollars.

Conclusions: The net benefit from widespread screening is unclear. A randomized prospective study of the effect of screening on prostate cancer mortality has therefore been initiated by the National Cancer Institute.

Publication types

  • Historical Article

MeSH terms

  • Aged
  • Health Care Costs
  • History, 20th Century
  • Humans
  • Male
  • Mass Screening / economics
  • Mass Screening / methods*
  • Middle Aged
  • Prostate-Specific Antigen / blood*
  • Prostate-Specific Antigen / history
  • Prostatic Neoplasms / diagnosis
  • Prostatic Neoplasms / mortality
  • Prostatic Neoplasms / prevention & control*
  • United States / epidemiology


  • Prostate-Specific Antigen