Clinical guidelines continue to move away from routine prostate specific antigen screening (PSA), once a widespread medical practice. A curious difference exists between early prostate cancer and early breast cancer. While randomized trials of therapy in early breast cancer continue to show overall survival benefit, this is not the case in prostate cancer, where prostatectomy was no better than observation in a recent trial, and where early androgen deprivation is no better than late androgen deprivation. Here, I make the case that prostate cancer screening contributes so greatly to over diagnosis that even treatment trials yield null results due to contamination with non-life threatening disease.
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Medical hypotheses. 2016 May 18 [Epub]
Division of Hematology Oncology, Knight Cancer Institute, Oregon Health & Science University, United States; Department of Public Health and Preventive Medicine, Oregon Health & Science University, United States; Senior Scholar in the Center for Health Care Ethics, Oregon Health & Science University, United States. Electronic address: .