To the Editor.
—In a decision analysis, a problem is stated, assumptions concerning probabilities and utilities are made, and a conclusion is reached based on the results. If the reader agrees with the structure, assumptions, probabilities, and utilities of the analysis, then he or she must agree with its conclusion. For the clinician, the main challenge to accept any conclusions drawn from a decision analysis is to decide if the analysis mirrors reality. After reviewing the manuscript and supplement published by Dr Krahn and colleagues,1 we feel their analysis differs enough from reality to prevent us from drawing firm conclusions. Many of their assumptions and the references used to support them are controversial. For instance, we are uncomfortable formulating recommendations for millions of men based essentially on two articles: the study by Johansson et al2 of 223 selected Swedish men with cancer, and the 52 cancers detected in
Miles BJ, Kattan MW, Giesler RB, Cowen M. Screening for Prostate Cancer. JAMA. 1995;273(15):1173-1174. doi:10.1001/jama.1995.03520390031018