Screening for cancer of the prostate: an evaluation of benefits, unwanted health effects and costs - nonsystematic review

Hanley J A, McGregor M
Record ID 31996008426
English, French
Authors' objectives:

To evaluate the benefits, adverse health effects and costs of screening asymptomatic men for cancer of the prostate.

Authors' results and conclusions: Since 1990, PSA testing in the province of Quebec has increased at least ten-fold and the operation of radical prostatectomy nearly three fold. Thus PSA screening followed by further testing, with eventual surgery, is rapidly becoming de facto accepted practice in Quebec. Based on reported data, it is estimated that a screening strategy based on PSA would miss approximately 15% of "fatal" cancers. It is also estimated that for every "fatal" cancer which requires treatment, approximately 5.4 non-fatal cancers will also be detected (i.e., 84% of cancers detected by screening would not prove fatal even if untreated). The study also suggests that the benefit of radical prostatectomy, if any, is unlikely to be substantial for a population subjected to regular screening. According to the estimates considered the most probable, 1 in every 100 operations would avert a death. According to the most optimistic and unlikely estimate considered, only 9 of every 100 such operations are likely to avert a death. It can be anticipated that 2 operations of every 100 will probably cause severe long term urinary incontinence and half of the men who were previously sexually potent will become permanently impotent and one of every 300 operations will cause death. The cost effectiveness of the most likely scenario of a screening programme would be $214,000 per year of life saved.
Authors' recomendations: From the perspective of the health care system, the health gains are too uncertain to justify the adverse health effects and the use of resources which would be associated with screening for prostate cancer based on PSA. Furthermore, the extent of the benefit which might result is relatively small. This is equally true for an organized comprehensive screening programme as it is for such screening as presently takes place in the context of case-finding. From the perspective of the individual whether a man, without special reason, should agree to (or insist on ?) the measurement of PSA is a decision with important consequences which each man should consider carefully in consultation with his medical advisor. Before his PSA is measured, such a man should be made fully aware of the possible results of undertaking this test.
Authors' methods: Review
Project Status: Completed
Year Published: 1995
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Canada
MeSH Terms
  • Costs and Cost Analysis
  • Mass Screening
  • Prostatectomy
  • Prostate-Specific Antigen
  • Prostatic Neoplasms
Organisation Name: Conseil d'Evaluation des Technologies de la Santé du Québec
Contact Address: Conseil d'Evaluation des Technologies de la Santé du Québec, 2021, avenue Union, #1040, Montréal, Québec H3A S29, Canada. Tel: 514-873-2563; FAX: 514-873-1369
Contact Name:
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Copyright: Conseil d'Evaluation des Technologies de la Sante du Quebec (CETS)
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