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E, lung, colorectal, and ovarian (plco) cancer screening trial randomly assigned 76,693 men between 55 and 74 years of age to annual psa screening in combination with digital rectal examination versus usual care (6). After 7 years' (complete) follow-up, screening was associated with increased prostate cancer incidence (relative risk [rr], 1. 2 [95% ci, 1. viagra 50 mg how long does it last 2 to 1. 3]) but no effect on prostate cancer–specific (rr, 1. 1 [ci, 0. 75 to 1. is viagra safe for people with high blood pressure 7]) or all-cause (rr, 0. 98 [ci, 0. 92 to 1. 0]) mortality. is viagra safe for people with high blood pressure Similar results were observed after 10 years (67% of sample; rr, 1. 1 [ci, 0. 80 to 1. order viagra online 5]). viagra online without prescription Up to 52% of men assigned to usual care underwent a psa test at some point during the trial, and 44% of trial participants had undergone psa screening before entry. The fair-quality european randomized study of screening for prostate cancer (erspc) randomly assigned 182,000 men aged 50 to 74 years from 7 countries to psa testing every 2 to 7 years (depending on center and year) or to usual care (7). Data from 2 other study centers were excluded for reasons not specified in the study protocol. viagra 5mg free trial Levels of psa for diagnostic evaluation ranged from 2. 5 to 4. 0 µg/l (1 center used 10 µg/l for several years). buy female viagra usa Recruitment and randomization procedures and age eligibility also varied. After a median of 9 years, prostate cancer incidence was higher in the screened group (net increase, 34 per yard men), but there was no statistically significant difference in prostate cancer–specific mortality (rr, 0. 85 [ci, 0. 73 to 1. 0]). A prespecified subgroup analysis of 162,243 men aged 55 to 69 years found that screening was associated with reduced prostate cancer–specific mortality (rr, 0. 80 [ci, 0. 65 to 0. 98]; absolute risk reduction, 0. viagra coupon 07 percentage point), for an estimated 1410 men invited to screening and 48 treated to prevent 1 prostate cancer–specific death. After publication of the main erspc results, 1 participating center (göteborg, sweden) reported results separately (21). It found psa screening (threshold, 2. 5 to 3. 0 µg/l) every 2 years in 20,000 men aged 50 to 64 years to be associated with increased prostate cancer incidence (hazard ratio [hr], 1. 6 [ci, 1. 5 to 1. 8]) and decreased risk for prostate cancer–specific mortality (rr, 0. 56 [ci, 0. 39 to 0. 82]; absolute risk reduction, 0. 34 percentage point) after a median of 14 years. Outcomes for 60% of participants were included in the main erspc report (7). Although no other center separately reported results, only exclusion of the swedish center data from the overall erspc analysis resulted in loss of the statistically significant effect of screening on prostate cancer–specific mortality (rr, 0. viagra samples 84 [ci, 0. generic viagra canada 70 to 1. 01]), suggesting better results than the other centers (7). Three poor-quality trials (number of men invited to screening ranged.