In Reply I do not see my recommendation for abandoning screening with the prostate-specific antigen (PSA) as Orwellian. I think of it as in the spirit of Hippocrates: First, do no harm.
When I think of a healthy 69-year-old man, as described by Dr Keller, I do not want to have an end-of-life discussion with him; I want to keep him healthy, continent, and (ideally) enjoying a great sex life. I do not want to subject him to tests that may cause a cascade of events that diminish the quality of his life, without data indicating that I am substantially increasing his survival. At the present time, the data do not show a survival advantage with PSA screening, which has led the US Preventive Services Task Force to conclude that “there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.”1(p122)
Katz MH. Why I Will Continue to Screen Prostate-Specific Antigen for Myself and Other Appropriate Men—Reply. JAMA Intern Med. 2014;174(1):164. doi:10.1001/jamainternmed.2013.11095