Prostate-Specific Antigen in Men With an Initial PSA Level of 3.0 ng/mL or Lower

ONE OF THE MOST COMMON cancer screening activities in the United States is the measurement of prostatespecific antigen (PSA) levels for the early detection of prostate cancer. In 2001, approximately 75% of men in the United States aged 50 years and older reported that they had previously undergone PSA screening and 54% have reported regular PSA screening. Prostate cancer screening with PSA has been controversial, as no studies have proven that this strategy reduces mortality from prostate cancer. After almost 2 decades of PSA screening in the United States, mortality from prostate cancer has decreased, but it is unknown if the mortality reduction is due to screening or to other factors such as treatment efficacy. Of concern relative to a causal interpretation is that prostate cancer mortality rates have declined in countries where PSA screening is uncommon. In the United States, regions with different rates of prostate cancer screening and treatment have similar rates of diseasespecific mortality. Author Affiliations: Department of Urology, University of Texas Health Science Center at San Antonio (Dr Thompson); Fred Hutchinson Cancer Research Center, Seattle, Wash (Dr Ankerst and Mss Chi and Goodman); University of Colorado, Denver (Dr Lucia); Cancer Research and Biostatistics, Seattle (Dr Crowley); National Cancer Institute, National Institutes of Health, Bethesda, Md (Dr Parnes); and Southwest Oncology Group, San Antonio (Dr Coltman). Corresponding Author: Ian M. Thompson, MD, Department of Urology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX 78229 ([email protected]). Reprint Requests: Southwest Oncology Group Operations Office, 14980 Omicron Dr, San Antonio, TX 78245-3217. Context Three fourths of US men older than 50 years have been screened with prostatespecific antigen (PSA) for prostate cancer.