Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor
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)?
McNaughton Collins M, Barry MJ, Ransohoff DF. Detection of Early Prostate Cancer: Serendipitous or Systematic?—Reply. JAMA. 1998;279(18):1439-1441. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-18-jac80006