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January 13, 1999

Talking With Patients About Screening for Prostate Cancer—Reply

Author Affiliations

Margaret A.WinklerMDIndividualAuthorPhil B.FontanarosaMD, Senior EditorsIndividualAuthor

JAMA. 1999;281(2):133. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-2-jac80019

In Reply: We appreciate the comments of Drs Rosenthal and Feldman and agree wholeheartedly that patient involvement in the decision to undergo PSA testing is of paramount importance. Indeed, the American College of Physicians concludes that it is inappropriate to perform PSA testing without a frank discussion of the issues.1

These discussions can be difficult and confusing to patients. One way to conduct this conversation concludes with the following remarks: "In summary, at this time it is clear that undergoing PSA testing puts a patient at risks of complications but may also decrease the patient's risk of dying of prostate cancer. Our best estimate is that PSA testing helps some men and hurts some men. Some men who undergo PSA testing may benefit by living longer. On the other hand, clearly some other men who undergo PSA testing have complications from the testing and treatment without achieving any benefit. Men who are concerned about prostate cancer and are willing to take the risk of medical and surgical complications may choose to undergo PSA testing and therapy, whereas other men who are more concerned about medical and surgical complications may choose not to undergo PSA testing."