To the Editor.
—The article by Dr Litwin and colleagues1 makes it clear that significant morbidity is associated with all modalities of managing localized prostate cancer, including surgery, radiation, and observation. Is there any way of avoiding this? A conceptually simple method would be to give the patient the opportunity of completely opting out of the prostate cancer case-finding process. The rationale for this is straightforward. First, in the absence of controlled prospective studies, it is unknown whether any case-finding procedure for prostate cancer decreases mortality.2,3 Second, the detection of a prostatic nodule on digital rectal examination (DRE) or the finding of an abnormal prostate-specific antigen (PSA) level results in a cascade of events that entail psychological and physical morbidity and sometimes even death.Were we to accept this approach, we would present each patient with the data required for him to give informed consent for a DRE
Marshall KG. Informed Consent for Tests for Prostate Cancer. JAMA. 1995;274(2):127-128. doi:10.1001/jama.1995.03530020045023