Prostatic specific antigen (PSA) screening has been controversial since its inception. Controversy has persisted despite more and higher quality clinical evidence. Attention to lead and length time biases, overdiagnosis, overtreatment, medicalisation, iatrogenesis and financial conflict of interest has had limited impact. I undertook a social history of the prostate cancer diagnosis to reassess the causes of controversy and suggest different clinical and policy responses.

For much of the twentieth century, clinicians were uninterested in early detection and radical treatment, believing that cancers revealed after obstruction-relieving surgery or autopsy could be ignored. In 1985, the FDA approved PSA diagnostic tests, which rapidly catalysed two self-reinforcing cycles of action and perception. One occurred when the increased diagnoses made the disease more prevalent and feared, and efforts at prevention and treatment seem more efficacious, leading to more screening, and so on. The other cycle occurred among men with screening detected cancer who initially eschewed radical treatments or imagined doing so, whose lives were often consumed with fear and surveillance, increasing demand for radical cures.

This history underscores the need for novel clinical and policy responses to the looping effects—self-reinforcing cycles of action and perception—which can radically transform so much of what we believe and do about disease.

自开始以来，前列腺特异性抗原（PSA）筛查一直存在争议。尽管有越来越多的高质量临床证据，争议仍然存在。注意提前期和时长偏差，过度诊断，过度治疗，医疗，医源性疾病和经济利益冲突的影响有限。我进行了前列腺癌诊断的社会史，以重新评估引起争议的原因并提出不同的临床和政策应对措施。

在20世纪的大部分时间里，临床医生对早期发现和根治性治疗不感兴趣，因为他们认为可以避免因阻塞性外科手术或尸检而发现的癌症。1985年，FDA批准了PSA诊断测试，该测试迅速促进了作用和感知的两个自我增强循环。当增加的诊断使该病更加普遍和令人恐惧，并且在预防和治疗方面的努力似乎更加有效，导致更多的筛查等时，便发生了一种情况。另一个周期发生在筛查发现患有癌症的男性中，他们最初避开了根治性治疗或想象过这样做，他们的生命常常被恐惧和监视所消耗，对根治性治疗的需求增加。

这段历史突显了对循环效应（行动和知觉的自我强化循环）的新颖临床和政策反应的需求，这种循环效应可以从根本上改变我们对疾病的信念和行为。