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January 22, 1997

Prostate Cancer Screening-Reply

Author Affiliations

Washington University School of Medicine St Louis, Mo

JAMA. 1997;277(4):300. doi:10.1001/jama.1997.03540280038030

In Reply.  —Dr Atkins takes issue with the implications of our article and presents the often-cited concerns about screening for prostate cancer with PSA testing. Further, he incorrectly states that our report implies no risk of detecting harmless cancers. In fact, our data suggest that serial screening may increase slightly the detection of clinically unimportant cancers. This issue is influenced to some extent by the definition of clinically unimportant cancer. We believe that basing the definition solely on the cancer mortality rate is too narrow. The suffering that patients experience from cancer progression and its treatment also must be considered.Dr Atkins mistakenly suggests that the dramatic increase in prostate cancer incidence is due to increasing performance of transurethral resection of the prostate. The increase in prostate cancer detection during the past 10 years is due largely to increased PSA testing, while the number of transurethral resections performed has decreased markedly.1