To the Editor.
—I read with interest the article by Carter et al1 regarding prostate-specific antigen (PSA) levels in men with and without prostate disease. I take issue, however, with the Editorial by Oesterling,2 which advocated the addition of PSA testing to digital rectal examination (DRE) for generalized screening to detect prostate cancer.Catalona et al3 have published the only study that attempts to evaluate the use of PSA tests in a screening population. This study has received significant criticism because patients from the screening group with normal PSA levels did not have biopsies; thus, sensitivity and specificity could not be determined. The study by Carter et al1 suffered from a similar flaw; the control group did not receive biopsies, and thus, we do not know how many of the patients presumed not to have prostate cancer actually did have it. To date, there has been no
Carlson SE. Cancer of the Prostate. JAMA. 1992;268(22):3196. doi:10.1001/jama.1992.03490220040011