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October 14, 2009

Prostate Cancer Screening and Surveillance—Reply

JAMA. 2009;302(14):1529-1530. doi:10.1001/jama.2009.1439

In Reply: Dr Rogers raises notable caveats regarding the clinical significance attributable to PSA screening observed in the ERSPC trial: improved survival associated with PSA screening (and consequent justifiable treatment of aggressive cancers) appears to come at the expense of overdiagnosis and overtreatment of low-risk cancers that have a potentially indolent clinical course. We acknowledge these limitations of PSA screening—and the burden this uncertainty brings to discussions between physicians and patients—in efforts to decide whether a man should undergo a PSA blood test and, if so, at what age and how frequently. As well-described in the Editorial1 that accompanied the ERSPC and PLCO trials, these studies represent laudable efforts but nevertheless have limitations that preclude them from providing a final resolution to the conundrum that mortality reduction from PSA screening is accompanied by overtreatment.

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