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April 4, 2012

Recommendations on Use of Prostate-Specific Antigen for Prostate Cancer Screening—Reply

Author Affiliations

Author Affiliations: University of Texas MD Anderson Cancer Center, Houston (jekim@mdanderson.org).

JAMA. 2012;307(13):1372-1374. doi:10.1001/jama.2012.398

In Reply: We disagree with Dr Garnick that our Commentary minimized the adverse effects of treatment when in fact it is because of those adverse effects that we promoted shared decision making for PSA screening and emphasized the importance of identifying men likely to have better outcomes with active surveillance than with treatment.

We also do not concur that our Commentary implied that being tested prevents metastatic disease and avoids prostate cancer–related death. What we described is what is observed when PSA screening is widely adopted: cases are detected earlier, causing a shift to detection of disease at earlier stages. This is a consequence of a change in the lens through which prostate cancer is observed.