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May 5, 1993

Screening With Prostate-Specific Antigen: Should We or Shouldn't We?

JAMA. 1993;269(17):2212. doi:10.1001/jama.1993.03500170042024

To the Editor.  —In a recent Editorial1 Lange reviewed the current evidence for prostate cancer screening. He described the key unresolved issue: whether screening should be done at all in asymptomatic men, given that there is no proof that early diagnosis leads to better health outcomes. I therefore did not understand the basis for his concluding recommendation that "for now the periodic prostate examination should be encouraged" pending the results of ongoing clinical trials. The opposite conclusion seems more appropriate.Sackett and colleagues2 have described screening for symptom-free individuals in terms of an implicit contract. By this view, we imply a promise to asymptomatic people "not that their subsequent treatment may work but that it does work; not that we will simply do our best, but that they will be better off as a result of the screening program. When we impose ourselves on the public in this