Decisions about prostate cancer screening in managed care.

This review contrasts a traditional biomedical model with an outcomes model and illustrates the distinction in approaches with regards to prostate cancer. The traditional biomedical model emphasizes diagnosis and treatment of medical conditions. The principal data are diagnosis and disease status. In contrast, an outcomes model emphasizes life expectancy and health-related quality of life. According to the traditional model, screening for prostate cancer is encouraged and focus is on the number of cases diagnosed and the success of treatment. Treatment success is measured by recurrence rates or disease-free survival; however, among all men with the potential for a diagnosis of prostate cancer, most will die of other causes. Treatment may have significant consequences in terms of quality of life without clear evidence that it improves survival. The outcomes model argues that decisions for screening and treatment of prostate cancer must be shared between an informed patient and his physician.