Why is prostate cancer screening so common when the evidence is so uncertain?
Ransohoff DF; McNaughton Collins M; Fowler FJ Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. ransohof@med.unc.edu The degree of enthusiasm for prostate cancer screening seems high given the limited evidence of benefit and the well-documented harms of treatment that include impotence and incontinence. The purpose of this review is to understand the reasons for enthusiasm and positive reinforcement perceived in clinical decisions about whether to screen, whether to choose aggressive therapy for cancer, and in how to view adverse effects following therapy. We discuss a case of a man who must decide whether to undergo prostate-specific antigen screening and treatment to illustrate the kinds of reinforcement that may occur for each decision.Strong positive reinforcement for each decision would make screening and aggressive therapy appear to be successful and the correct decision even if prostate cancer screening and therapy were
