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May 13, 1998

Detection of Early Prostate Cancer: Serendipitous or Systematic?

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(18):1439-1441. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-18-jac80006

To the Editor.—Dr McNaughton Collins and colleagues1 emphasize the role that chance plays in tissue sampling during prostate cancer screening, but this chance is a small aspect of the uncertainty that confounds an evidence-based approach to determining the clinical value of "early cancer" detection. A more important impact of chance in screening is embedded in the prognostic information communicated by the tissue diagnosis.2 This chance component of the histopathologic diagnosis has changed in parallel with the successful detection of early cancer in asymptomatic patients. When cancer symptoms prompt biopsy, histopathological evaluation labels the morphological abnormality as "cancer," which both explains the symptoms and predicts a very high chance for future morbidity or mortality due to the cancer. For asymptomatic patients, screening thrusts histopathology into a predispositional testing role; the pathology diagnosis of early cancer still documents a phenotypic deviation from normal, but in this context the diagnosis often is expected to predict elevated but relatively low risk for future clinically apparent illness.

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