One man at a time--resolving the PSA controversy.

1951 on health care spending and physicians’ time and energy. We believe that the current PSA-based screening paradigm does not compare favorably with competing health care priorities. Some people have argued that PSA screening should at least be available for black men, because the incidence and aggressiveness of prostate cancer are greater in black than in white Americans. This proposal, however well intentioned, is misguided. In 2007, the proportion of deaths among U.S. men that were attributed to prostate cancer was 3.3% among blacks and 2.3% among whites; these rates are close enough that racespecific distinctions for screening are unwarranted. Furthermore, there is no evidence that the balance of benefits and harms from PSA screening differs for blacks and whites. If PSA screening is worthwhile, it should be applied universally; if it is not, selective screening would be a disservice to black men. Eliminating the unconscionable racial gap in overall access to essential health care services would be a far better way to address disparities than promoting a questionably effective cancerscreening program: the percentage of blacks without medical insurance is nearly twice that of whites.5 For two decades, primary care physicians have been expected to present a flawed screening test to patients, cloaking the flaws in an elaborate ritual of informed decision making. In turn, men have been expected to make sense of a confusing mix of hypothetical outcomes. Although the USPSTF recommendation is unlikely to end the PSA controversy, a document finally exists that should provide guidance to clinicians and policymakers.