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May 13, 1998

Detection of Early Prostate Cancer: Serendipitous or Systematic?—Reply

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

In Reply.—We agree with Drs Iczkowski and Bostwick that the harder one looks (the more biopsy samples one sees) the more prostate cancer one finds. But why rely on DRE to choose men for such careful scrutiny? If a DRE prompted the biopsy, and the biopsy of that suspicious area was negative (truly or falsely), then finding cancer elsewhere is still serendipitous. Presumably, if men have biopsies for DRE abnormalities alone, the positive predictive value (PPV) of the biopsies of the "nonsuspicious" areas would be less than 5% (based on an overall PPV of 10% when the DRE is positive with a low PSA, and the detection of less than 50% of cancers outside of suspicious areas). Might we do even better with 2 sets of 13 biopsies each on all men with brown eyes, regardless of DRE and PSA results ("pure" serendipity)?

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