—We agree with the comments of Drs Maloney and Green. Certainly, the true efficacy of screening requires a demonstration of a reduction in disease-specific mortality. A variety of factors, such as lead-time and length-time biases, as well as possible overdetection of prostate cancer, may falsely suggest benefit from screening when none truly exists. While the National Cancer Institute is undertaking a randomized, prospective trial to study this issue, results will not be available for approximately 16 years. In the meantime, physicians must make their best judgment regarding prostate cancer screening: who should be screened and when and how? In light of recent studies from Europe regarding the excellent 10-year survival of men with well- to moderately differentiated tumors treated by observation and/or palliative therapy alone,1 it seems reasonable to limit screening to men with at least a 10-year life expectancy. In addition, since the true efficacy of
Gerber GS, Thompson IM, Thisted R, Chodak GW. Digital Rectal Examination Screening for Prostate Cancer-Reply. JAMA. 1993;270(11):1315–1316. doi:10.1001/jama.1993.03510110051018
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