Treatment of Localized Prostate Cancer in the Era of PSA Screening

Many experts are concerned about overly aggressive treatment of clinically insignificant prostate cancer that is detected by prostate-specific antigen (PSA) screening. Researchers used linked Medicare and cancer registry databases to assess mortality in 14,516 older men (age, >65; median age, 78) with diagnoses of localized (stage T1 or T2) prostate cancer during the early era of PSA testing (1992–2002) who did not die or receive prostatectomy or radiation during the first year after their diagnoses (median follow-up, about 8 years).

For patients with highly, moderately, and poorly differentiated cancers, 10-year prostate cancer–specific mortality was 8%, 9%, and 26%, respectively; mortality from all other causes was about 60% in all three g…