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Should we screen for prostate cancer? A re-examination of the evidence

The potential harms from diagnosis, overdiagnosis and treatment must not be overlooked

Despite the results of two large, but conflicting, trials published side by side in 2009, whether prostate cancer screening is beneficial or harmful (or indeterminate) remains unresolved.1,2 Those on either side of the debate read the same information but interpret it differently, declaring that it supports their unchanged positions.

That prostate cancer is important is not at issue: it is the ninth-ranked cause of disease burden in men in Australia, representing the loss of 36 000 disability-adjusted life-years (DALYs), or 2.7% of the total Australian loss, in 2003.3 This is about two-thirds of the loss resulting from breast cancer in women (60 000 DALYs; 4.8%). A positive family history of prostate cancer is associated with increased risk (typically a risk ratio of about 2),4 although this risk may be exaggerated by detection bias (men with a positive family history are more likely to have a screening test).5 Associations with family history of other conditions…