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Both proponents and opponents of prostate-specific antigen (PSA) screening agree that too-frequent screening can result in overdiagnosis of nonlethal prostate cancer and excessive downstream intervention. In several studies, low PSA levels in middle age were associated with very low risk for developing lethal prostate cancer. In this nested case-control study, researchers used stored baseline blood samples obtained between 1982 and 1984 from thousands of men who participated in the U.S. Physicians' Health Study.
During 30 years of follow-up, 71 men (age range, 40–59 at baseline) developed lethal prostate cancer (i.e., fatal cancer or nonfatal metastatic cancer). PSA level at baseline strongly predicted subsequent risk for lethal prostate can…