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In Reply: Dr Rogers raises notable caveats regarding the clinical significance attributable to PSA screening observed in the ERSPC trial: improved survival associated with PSA screening (and consequent justifiable treatment of aggressive cancers) appears to come at the expense of overdiagnosis and overtreatment of low-risk cancers that have a potentially indolent clinical course. We acknowledge these limitations of PSA screening—and the burden this uncertainty brings to discussions between physicians and patients—in efforts to decide whether a man should undergo a PSA blood test and, if so, at what age and how frequently. As well-described in the Editorial¹ that accompanied the ERSPC and PLCO trials, these studies represent laudable efforts but nevertheless have limitations that preclude them from providing a final resolution to the conundrum that mortality reduction from PSA screening is accompanied by overtreatment.

Dilemmas regarding cost-effectiveness of PSA screening that cannot be resolved due to limitations of the ERSPC . . . [Full Text of this Article]

Martin G. Sanda, MD
Division of Urology

Irving D. Kaplan, MD
Department of Radiation Oncology
Beth Israel Deaconess Medical Center
Boston, Massachusetts

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