DRS OOTTAMASATHIEN and Crawford and I agree that prostate cancer is an important public health problem and that PSA testing should be included as part of an optimal screening strategy. However, I am less convinced that current evidence supports the efficacy of PSA testing. Even though mortality rates have been declining since 1992, the rates are only slightly lower than they were before the advent of PSA testing.1- 4 Plausible explanations for the mortality trends still include improved palliative treatments for advanced cancers and attribution bias. Furthermore, population data on screening and prostate cancer mortality are also susceptible to the ecological fallacy—just because screening rates have increased and mortality rates have decreased does not prove that mortality was lower among men who actually underwent screening. Results from ongoing randomized trials will provide the most valid assessment of screening efficacy.
Hoffman RM. Rebuttal by Dr Hoffman. Arch Intern Med. 2003;163(6):666. doi:10.1001/archinte.163.6.666