To the Editor.
—The Editorial by Oesterling1 recommended screening all men over the age of 55 years for early prostate cancer with annual DRE and PSA levels. This recommendation violates one of the basic principles for deciding to screen for a medical condition during periodic health examinations. In order for a screening procedure to be beneficial, there must be evidence that treating the disease earlier results in decreased morbidity. In the Editorial, Oesterling admits that there is no conclusive evidence that early treatment with radical prostatectomy or radiation therapy is beneficial for all patients with early prostate cancer. Consequently, recommending mass screening for early prostate cancer at this time is, at best, premature. In light of the great variability in the natural history of untreated early prostate cancer reported by Johansson et al,2 it seems more prudent to await proof that treating early prostate cancer does improve morbidity
Layson RT. Cancer of the Prostate. JAMA. 1992;268(22):3197. doi:10.1001/jama.1992.03490220040013