To the Editor.
—The recent article by Dr Smith and colleagues1 provides important data on serial screening with prostate-specific antigen (PSA), but does little to allay the concerns expressed by many groups about widespread prostate cancer screening. The authors report that the cancer detection rate among screened men eventually decreases to approximate the population-based incidence rate, implying that screening does not result in overdiagnosis of clinically unimportant cancers. There are 2 serious problems with this argument. First, the cumulative cancer incidence among men screened for 4 years remains much higher than that in the general population due to the large number of prevelant cancers detected at the initial screening test; second, the current population-based incidence of prostate cancer itself overestimates the incidence of clinically important cancers (ie, cancers likely to cause metastasis or death). Incidence of prostate cancer in the United States has doubled in the past 10 years,
Atkins D. Prostate Cancer Screening. JAMA. 1997;277(4):299-300. doi:10.1001/jama.1997.03540280037029