***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE Screening with serum prostate specific antigen testing leads to the detection of many prostate cancers early in their natural history . Statistical models have been proposed to predict indolent cancer . We vali date d and up date d model predictions for a screening setting . MATERIAL S AND METHODS We selected 247 patients with clinical stage T1C or T2A from the European R and omized Study on Screening for Prostate Cancer who were treated with radical prostatectomy .  We vali date d a nomogram that had previously been developed in a clinical setting . Predictive characteristics were serum prostate specific antigen , ultrasound prostate volume , clinical stage , prostate biopsy Gleason grade , and total length of cancer and noncancer tissue in biopsy cores . Indolent cancer was defined as pathologically organ confined cancer 0.5 cc or less in volume without poorly differentiated elements . Logistic regression was used to up date the previous model and examine the contribution of other potential predictors . RESULTS Overall 121 of 247 patients ( 49 % ) had indolent cancer , while the average predicted probability was around 20 % ( p < 0.001 ) . Effects of individual variables were similar to those found before and discriminative ability was adequate ( AUC 0.76 ) . An up date d model was constructed , which merely recalibrated the nomogram and did not apply additional predictors . CONCLUSIONS Prostate cancers identified in a screening setting have a substantially higher likelihood of being indolent than those predicted by a previously proposed nomogram . However , an up date d model can support patients and clinicians when the various treatment options for prostate cancer are considered BACKGROUND There is no conclusive evidence that screening based on serum prostate-specific antigen ( PSA ) tests decreases  prostate-cancer mortality . Since its introduction in the USA around 1990 , uptake of PSA testing has been rapid in the USA , but much less common in the UK . Our aim was to study trends over time in  prostate-cancer mortality and incidence in the USA and UK in 1975 - 2004 , and compare these patterns with trends in screening and treatment . METHODS Joinpoint regression analysis of cancer-mortality statistics from Cancer Research UK ( London , UK ) and from the US National Cancer Institute Surveillance , Epidemiology and End Results ( SEER ) programme from 1975 to 2004 was used to estimate the annual percentage change in prostate-cancer mortality in both countries and the points in time when trends changed . The ratio of USA to UK age-adjusted prostate-cancer incidence was also assessed . FINDINGS Age-specific and age-adjusted prostate-cancer mortality peaked in the early 1990s at almost identical rates in both countries , but age-adjusted mortality in the USA subsequently declined after 1994 by -4.17 % ( 95 % CI -4.34 to -3.99 ) each year , four-times the rate of decline in the UK after 1992 ( -1.14 % [ -1.44 to -0.84 ] ) . The mortality decline in the USA was greatest and most sustained in patients aged 75 years or older ( -5.32 % [ -8.23 to -2.32 ] ) , whereas death rates had plateaued in this age group in the UK by 2000 . The mean ratio of USA to UK age-adjusted prostate-cancer incidence rates in 1975 - 2003 was 2.5 , with a pronounced peak around the time that PSA testing was introduced in the USA . Numbers needed to treat to prevent one death from prostate cancer were 33 000 in the 55 - 64-year age group . INTERPRETATION The striking decline in prostate-cancer mortality in the USA compared with the UK in 1994 - 2004 coincided with much higher uptake of PSA screening in the USA . Explanations for the different trends in mortality include the possibility of an early effect of initial screening rounds on men with more aggressive asymptomatic disease in the USA , different approaches to treatment in the two countries , and bias related to the misattribution of cause of death . Speculation over the role of screening will continue until evidence from r and omised controlled trials is published A consensus meeting on screening and global strategy for prostate carcinoma , held in Antwerp in 1994 , determined the willingness among European cancer prevention centers to pursue vigorously the collaborative formation of a multinational r and omized screening trial . This trial was to be named the European R and omized Study of Screening for Prostate Cancer ( ERSPC ) PURPOSE Despite the tremendous stage migration associated with prostate cancer screening to our knowledge it remains unproven whether prostate specific antigen based screening decreases prostate cancer specific mortality . Recent studies have shown that prostate specific antigen velocity more than 2 ng/ml per year in the year before diagnosis is associated with a significantly greater risk of prostate cancer specific mortality after treatment . This may serve as a surrogate marker for prostate cancer outcomes . We compared the prostate specific antigen velocity profile between patients with prostate cancer in whom the tumor was detected in a formal screening study and those who were referred for treatment . MATERIAL S AND METHODS We evaluated prostate specific antigen velocity in 1,101 men from a prostate cancer screening study and in 368 not enrolled in a screening study who were referred for treatment . All patients underwent radical prostatectomy for clinical ly localized disease and had multiple preoperative prostate specific antigen measurements to calculate prostate specific antigen velocity . RESULTS Median prostate specific antigen velocity before diagnosis was significantly higher in referred vs screened men ( 1.35 vs 0.68 ng/ml per year , p < 0.0001 ) . In addition , a significantly greater proportion of referred patients had prostate specific antigen velocity more than 2 ng/ml per year ( 38 % vs 17 % , p < 0.0001 ) . On multivariate analysis using prostate specific antigen , clinical stage and biopsy Gleason score screened vs referred status was a significant independent predictor of prostate specific antigen velocity more than 2 ng/ml per year ( p < 0.0004 ) . CONCLUSIONS Prostate specific antigen velocity more than 2 ng/ml per year has been linked to a significantly greater risk of prostate cancer specific mortality . Patients who underwent serial screening had a more favorable prostate specific antigen velocity profile at diagnosis , suggesting that screen detected prostate cancer may be more likely to be cured with definitive therapy OBJECTIVES To determine the prostate-specific antigen ( PSA ) velocity , PSA slope , and PSA doubling time ( PSADT ) in men with positive biopsies , negative biopsies , and no biopsy indications 4 years after an initial screening ;  and to use this information to improve the test characteristics in the early detection of prostate cancer and provide normal values for these parameters in screened men with and without evidence of prostate cancer . METHODS Within the European R and omized Study of Screening for Prostate Cancer , section Rotterdam , we identified 9575 men with a second determination of PSA 4 years after the initial screening . These men were divided into three groups : men with positive biopsies , negative biopsies , and no biopsy  indications in the  second  round ( PSA less than 3.0 ng/mL ) . The predictive values of PSA dynamics for detection of prostate cancer were calculated . RESULTS The mean PSA velocity of men with prostate cancer was 0.62 ng/mL/yr versus 0.46 ng/mL/yr for men with a negative biopsy ( P = 0.001 ) . The mean PSADT for men with prostate cancer was 5.1 years and for those with a negative biopsy it was 6.1 years ( P = 0.002 ) . The PSADT for men with no indication for biopsy was 25.1 years . However , receiver operating characteristic analyses revealed only a moderate value for these test parameters in predicting biopsy outcome . CONCLUSIONS The mean values of PSA velocity , PSA slope , and PSADT in a rescreened population differed significantly between men with and without prostate cancer . However , in predicting the biopsy outcome , the PSA dynamics were of limited value In a study of 2,400 r and omly selected men ( age 55 - 70 years ) for early detection of prostate cancer  the authors have compared the diagnostic value of  digital rectal examination ( DRE ) , transrectal ultrasound ( TRUS ) and prostate specific antigen ( PSA ) .  Altogether 62 prostate cancers were detected , corresponding to a detection rate of 3.5 % but by use of DRE the detection rate was only 2.3 % . The study showed that TRUS added significantly to the detection rate . If radical surgery is restricted to stages T1 and T2A , the combined use of DRE and TRUS detected twice as many cases fit for this treatment than DRE alone . The authors advocate r and omized studies for evaluation of early radical treatment of prostate cancer . Before results of such studies have appeared they recommend method ological studies aim ed at development and enhancement of the accuracy of the diagnostic tools PURPOSE Early detection of prostate cancer has been recommended for men with affected first-degree relatives despite the lack of evidence for mortality reduction . We therefore evaluated the impact of family history in the Finnish prostate cancer screening trial . PATIENTS AND METHODS Approximately 80,000 men were identified from the population register for the first screening round . Of the 32,000 men r and omized to the screening arm , 30,403 were eligible at the time of invitation . A blood sample was drawn from the participants ( n = 20,716 ) , and serum prostate-specific antigen ( PSA ) was determined . Men with a PSA level > or = 4.0 ng/mL were referred for prostate biopsy . Information on family history was obtained through a self-administered question naire at baseline . RESULTS A total of 964 ( 5 % ) of the 20,716 screening participants had a positive family history , and 105 ( 11 % ) were screening-positive . Twenty-nine tumors were diagnosed , corresponding to a detection rate of 3.0 % ( 29 of 964 ) and a positive predictive value of 28 % ( 29 of 105 ) . Of the 19,347 men without a family history , 1,487 ( 8 % ) had a PSA level > or = 4.0 ng/mL. The detection rate was 2.4 % ( 462 of 19,347 ) and the positive predictive value was 31 % ( 462 of 1,487 ) . The risk associated with a positive family history was not substantially increased ( rate ratio , 1.3 ; 95 % confidence interval , 0.9 to 1.8 ) . The results were not affected by the age of the screenee or age at diagnosis of the affected relative . The program sensitivity was 6 % ( 29 of 491 ) ( ie , selective screening policy would have missed 94 % of cancers in the population ) . No differences were seen in the characteristics of screen-detected cancers by family history . CONCLUSION Our findings provide no support for selective screening among men with affected relatives The Prostate , Lung , Colorectal and Ovarian ( PLCO ) Cancer Screening Trial is enrolling 148,000 men and women ages 55 - 74 at ten screening centers nationwide with balanced r and omization to intervention and control arms . For prostate cancer , men receive a digital rectal examination and a blood test for prostate-specific antigen . For lung cancer , men and women receive a posteroanterior view chest X-ray . For colorectal cancer , men and women undergo a 60-cm flexible sigmoidoscopy . For ovarian cancer , women receive a blood test for the CA125 tumor marker and transvaginal ultrasound . Members of the control arm continue with their usual care . Follow-up in both groups will continue for at least 13 years from r and omization to assess health status and cause of death . The primary endpoint is mortality from the four PLCO cancers , which accounts for about 53 % of all cancer deaths in men and 41 % of cancer deaths in women in the United States each year . Blood specimens are collected from screened participants , buccal cell DNA from controls , and histology slides from cases ; these are maintained in a biorepository . Participants complete a baseline question naire ( covering health status and risk factors ) and a dietary question naire . More than 12,000 participants were enrolled in the pilot phase ( concluded in September 1994 ) . Changes in the eligibility criteria followed . As of April 2000 , enrollment exceeded 144,500 . Data are scanned into design ated on-site computers for uploading by participant identification number to the coordinating center for quality checks , archival storage , and preparation of analysis data sets for use by the National Cancer Institute ( NCI ) . Scientific direction is provided by NCI scientists , trial investigators , external consultants , and an independent data safety and monitoring board . Performance and data quality are monitored via data edits , site visits , r and om record audits , and teleconferences . The PLCO trial is formally endorsed by the American Cancer Society and has been ranked by the American Urological Association as one of the most important prostate cancer studies being conducted . Special efforts to enroll black participants are cosponsored by the U.S. Centers for Disease Control and Prevention BACKGROUND Residents are required to demonstrate competency in communication skills . Prostate cancer screening discussion s are examples of complex physician-patient communication processes , requiring an objective presentation of the known risks , potential benefits , and scientific uncertainties surrounding screening . National organizations recommend shared decision making ( SDM ) in these discussion s. METHODS A stratified analysis to contrast resident and faculty outcomes was planned as part of a r and omized controlled trial comparing decision aids for prostate cancer screening in a suburban Washington , DC , residency practice . All 
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AUTHORS ' CONCLUSIONS Given that only two r and omised controlled trials were included , and the high risk of bias of both trials , there is insufficient evidence to either support or refute the routine use of mass , selective or opportunistic screening compared to no screening for reducing prostate cancer mortality .