Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. Jun 26, 2015; 5(2): 10-12
Published online Jun 26, 2015. doi: 10.5662/wjm.v5.i2.10
Ability of community-based prostate cancer screening to target an appropriate and underserved population
Jared Moss, Eric Heidel, Jason Johnson, Chase Powell, Erin Dittrich, Susan Rawn, Paul D Terry, Mitchell Goldman, W Bedford Waters, Wesley M White
Jared Moss, W Bedford Waters, Wesley M White, Division of Urologic Surgery, the University of Tennessee Medical Center, Knoxville, TN 37920, United States
Eric Heidel, Jason Johnson, Chase Powell, Erin Dittrich, Susan Rawn, Paul D Terry, Mitchell Goldman, Department of Surgery, the University of Tennessee Medical Center, Knoxville, TN 37920, United States
Paul D Terry, Departments of Public Health and Surgery, the University of Tennessee, Knoxville, TN 37996, United States
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paul D Terry, PhD, MPH, FACE, Departments of Public Health and Surgery, the University of Tennessee, 1914 Andy Holt Ave., HPER 390, Knoxville, TN 37996, United States. pdterry@utk.edu
Telephone: +1-865-9741108
Received: February 9, 2015
Peer-review started: February 9, 2015
First decision: April 10, 2015
Revised: April 27, 2015
Accepted: May 27, 2015
Article in press: May 28, 2015
Published online: June 26, 2015
Processing time: 148 Days and 12.1 Hours
Abstract

Screening is not universally beneficial due to over- and under-diagnosis, and false positives that beget additional testing and associated adverse events and expense. We examined data from all men who participated in a mass community prostate cancer screening between May 2009 and September 2010. The data contained information regarding patient demographics, family history of prostate cancer, lower urinary tract symptoms, prior history of prostate cancer, most recent digital rectal examination, and the presence of an established relationship with a physician. Current American Urological Association screening recommendations were then applied to determine the appropriateness of our outreach effort. A total of 438 men (mean age 66.5 years) underwent screening. A total of 106 (24.2%) patients in our study met contemporary criteria for screening. Of these men, the vast majority was well educated, well insured, and well informed about the need for prostate cancer screening. Based on these data, mass community-based prostate cancer screening does not appear to identify and screen at-risk men. Future efforts at mass screening should more carefully target men most likely to benefit.

Keywords: Prostate cancer; Screening; Outcomes; Prostate specific antigen; Community health

Core tip: Mass prostate specific antigen-based prostate screening is used throughout the world as a means of reducing prostate cancer morbidity and mortality. However, a large proportion of men who underwent mass screening in our region were, in hindsight, not appropriate candidates for screening. Given the recent warnings of the United States Preventative Services Task Force and American Urological Association regarding the over-diagnosis of prostate cancer, it is incumbent on urologists, hospitals, and public health agencies to critically examine the role of screening practices, recognizing both the potential for community benefit and of harm from inappropriate screening.