NLM Director's Comments Transcript
What's the Ultimate Goal of Prostate Cancer Screening?: 01/23/2012

Greetings from the National Library of Medicine and MedlinePlus.gov
Regards to all our listeners!
I'm Rob Logan, Ph.D. senior staff National Library of Medicine for Donald Lindberg, M.D, the Director of the U.S. National Library of Medicine.
Here is what's new this week in MedlinePlus.

Is the goal of prostate cancer screening to increase its detection, or reduce mortality? This question is posed prominently in a comprehensive study of adult men recently published in the Journal of the National Cancer Institute.
The systematic, randomized study of 76,685 men (ages 55-74), who enrolled at 10 screening centers across the U.S., suggests the comparative incidence of prostate cancer was 12 percent higher for an intervention group who received annual prostate cancer screenings. The intervention group's annual screenings included a prostate specific antigen (PSA) test for six years and a digital rectal exam (DRE) test for four years. While the control group received annual checks-ups, they received either no annual prostate cancer tests or what the authors describe as occasional ‘opportunistic screening.’
The study’s 24 authors explain the comparatively higher rate of detected prostate cancer in the study’s intervention group is statistically significant.
Nevertheless, after 13 years of follow up, the study also found no differences in the mortality rates between the two groups. In other words, the men who received prostate cancer screenings (and whose cancer was more likely to be detected) did not experience lower mortality rates than the male participants in the study who may or may not have received the same level of annual prostate cancer screenings. In addition, there were no differences in mortality rates between the two groups when the authors controlled for age, pretrial PSA testing, and comorbidity (or other illnesses).
Moreover, the study found the intervention group (who received annual screenings) experienced more false positive prostate cancer test results plus related health costs and challenges as a result of what the authors term an ‘overdiagnosis’ of prostate cancer.
Overall, the authors suggest annual screening for prostate cancer had no effect on mortality among the trial participants after 13 years. The authors write (and we quote): ‘the trial was evaluating the effect of adding an organized component of annual screening to the opportunistic screening already in place, and as far as the follow-up has been continued to date (13 years), there is no evidence of a benefit’ (end of quote).
Since the study’s findings are based on a larger, ongoing clinical trial (the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial sponsored by the National Cancer Institute), the authors do not address the clinical implications of the study’s findings. The current findings are akin to a snapshot of a stage of a long-term trial that may produce more insights in the future.
The authors carefully explain the similarities and differences between the study’s current findings and other large prostate cancer clinical trials in the U.S. and other nations. The authors note the current study’s findings are consistent with their previous research, but challenge the findings in some international studies.
While the authors carefully keep the door open for new findings, the study strongly suggests future research outcomes will provide insights if prostate cancer screenings do not reduce mortality rates and if widely used prostate cancer tests are not demonstrated to be clinically efficacious for men over time.
Meanwhile, a good introduction to the medical issues and clinical decisions surrounding prostate cancer is provided by the Mayo Foundation for Medical Education and Research – and is found in the ‘overviews’ section of MedlinePlus.gov’s prostate cancer health topic page. MedlinePlus.gov’s prostate cancer health topic page also provides links to comprehensive information about the diagnosis/symptoms, treatment, and prevention of prostate cancer.
The American Cancer Society explains some revised prostate cancer screening guidelines in the ‘prevention/screening’ section of MedlinePlus.gov’s prostate cancer health topic page. A guide to help men make decisions about annual prostate screenings is provided by the U.S. Centers for Disease Control and Prevention also within the ‘prevention/screening’ section.
To keep up with the type of questions raised by the current study, MedlinePlus.gov’s prostate cancer health topic page contains updated research summaries, which are available within the ‘research’ section. Links to the latest pertinent journal research articles are available in the ‘journal articles’ section. Links to related clinical trials that may be occurring in your area are available in the ‘clinical trials’ section. From the prostate cancer health topic page, you can sign up to receive email updates with links to new prostate cancer information as it becomes available on MedlinePlus.
To find MedlinePlus.gov’s prostate cancer health topic page, type ‘prostate cancer’ in the search box on MedlinePlus.gov’s home page, then, click on ‘prostate cancer (National Library of Medicine).’
Other helpful, related health topic pages within MedlinePlus.gov include: prostate diseases, cancers, and male reproductive system.
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NLM Director's Comments Transcript - What's the Ultimate Goal of Prostate Cancer Screening?