Recommendations on screening for prostate cancer with the prostate-specifi antigen test

• The prevalence of undiagnosed prostate cancer at autopsy is high and increases with age (> 40% among men aged 40-49 yr to > 70% among men aged 70-79 yr)

• Only a small proportion of men with prostate cancer have symptoms or die from the disease; most prostate cancers are slowly progressive and not life threatening.

• Screening with the PSA test may lead to a small reduction in prostate cancer mortality but not a reduction in all-cause mortality.

• Thresholds for PSA of 2.5 to 4.0 ng/mL are commonly used for screening; lower thresholds increase the probability of false-positive results, and no threshold completely excludes prostate cancer.

• Harms associated with PSA screening (e.g., bleeding, infection, urinary incontinence, a false-positive result and overdiagnosis) are common.

• The PSA test should not be used for screening without a detailed discussion with the patient, ideally with the use of decision aids to facilitate comprehension.


Treating delirium tremens


Recently the New England Journal published a review article about delirium tremens which is somewhat misguided (see a scathing critique by The Poison Review).  The article focused on traditional benzodiazepine therapy, overlooking recent evidence about phenobarbital.  This post will explore how phenobarbital might fit into the treatment regimen for delirium tremens.