Prostate Cancer Screening: What We Know, Don’t Know, and Believe

Prostate cancer is a devastating illness. Approximately28 000 American men will die of it this year (1). A method to prevent these deaths is sorely needed. For more than 20 years, many have believed that screening asymp-tomatic men of a certain age with serum prostate-specific antigen (PSA) is that method. Yet, every medical interven-tion has some harms associated with it, and we must weigh those harms against potential benefits. Potential harms of PSA screening are well-documented (2), but questions sur-round the potential benefits: Does PSA-based screening lead to decreased morbidity and mortality? If beneficial, do the benefits outweigh the harms? After a review of the evidence about both the benefits and harms of PSA screening and treatment of localized prostate cancer, the U.S. Preventive Services Task Force (USPSTF) gave PSA screening a grade of “D ” (3). This i