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Controversies in PSA screening
  1. Jack O’Sullivan
  1. Correspondence to Dr Jack O’Sullivan, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK; jack.osullivan{at}

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Forty years after its discovery, a reanalysis of the two largest trials to date, controversially suggests that prostate-specific antigen (PSA) screening may actually be beneficial.

Most healthcare organisations do not recommend PSA screening for prostate cancer,1 2 mainly in response to conflicting evidence about the benefits and clear evidence of harms. PSA can lead to false positive or ‘overdiagnosed’ cancer (detecting prostate cells that histologically represent cancer, but will never grow to cause a patient harm).

Evidence regarding efficacy has been based on two large randomised controlled trials: The European Randomised Study of Screening for Prostate Cancer (ERSPC)3 and Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO).4 These trials are both considered to be of high quality, but the trials came to …

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