Several approaches such as PSA velocity,1 free PSA,2 or even new biopsy method3 have been used to increase the specificity of PSA. We agree that these methods may enhance our ability to distinguish indolent cancers from aggressive ones. However, none of these methods have sufficient evidence to change current screening practice and prostate cancer management. Our study4 quantified the downstream impact of overdiagnosis and overtreatment at a population based level. A sizeable proportion of older men with low-risk cancer underwent aggressive treatment, and a lot of men who started with conservative management later received androgen deprivation therapy within a few years after cancer diagnosis. The prerequisite of a screening program is effective treatment; however, no prostate cancer treatment has been shown to improve prostate cancer-specific survival among older men.5 We could prevent a lot of older men from treatment complications and psychological stress by limiting PSA screening to those who are more likely to benefit from cancer treatment.
Shao Y, Lu-Yao GL. Time to Rethink PSA Screening—Reply. Arch Intern Med. 2011;171(6):595-596. doi:10.1001/archinternmed.2011.82