1	The Science of Early Detection Otis W. Brawley, M.D. Director Georgia Cancer Center Professor of Medicine, Oncology and Epidemiology Winship Cancer Institute Emory University Atlanta, Georgia, U.S.A.
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21	The Prostate Cancer Prevention Trial Finasteride versus placebo in men median age 62 with PSA < 3. Rigorous PSA and DRE for seven years with all men biopsied at end of study.
22	The Prostate Cancer Prevention Trial The placebo arm 12.2 % had prostate cancer diagnosed due to an abnormal PSA or DRE 15% of men with normal PSA and DRE for seven years had prostate cancer diagnosed on terminal biopsy
23	The Prostate Cancer Prevention Trial A total of 27% of men median aged 69 had prostate cancer. Less than half were diagnosed due to screening. In non-screening Western countries 3% of men die from prostate cancer. In the U.S. a 60 year old male has less than a 3% chance of dying from prostate cancer.
24	The Prostate Cancer Prevention Trial 6% of participants on the placebo arm diagnosed with high gleason grade disease 3% of American men die of prostate cancer
25	Overdiagnosis Scientific ability to diagnose cancer has outpaced scientific ability to predict the biologic behavior of tumors. Overdiagnosis leads to overtreatment and excess human suffering and other societal costs.
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