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The dilemmas of prostate cancer screening

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Prostate cancer screening is controversial — the screening decision must be based on high-quality evidence

Screening for cancer, especially screening for prostate cancer with prostate-specific antigen (PSA), is one of the most controversial subjects in medicine today. The main dilemma is that one aims for a beneficial effect on the population level, but on the individual level, some will only be harmed without any gain from participation — such as those in whom the cancer detected is already too advanced at diagnosis, and those diagnosed with a harmless disease that will not surface as a clinical cancer during the lifetime (overdiagnosis). These individuals will unnecessarily be “labelled” as patients for many years, are likely to be treated unnecessarily and suffer from the side effects of treatment (overtreatment) without altering the risk of prostate cancer mortality.

As individuals have various viewpoints of what is an acceptable harm-to-benefit ratio, most professional organisations and guideline groups today emphasise shared decision making and stipulate that “screening must be preceded by a discussion regarding risks and benefits”,1 so that individuals can make the choice they feel is in line with their personal…