Early Detection of Prostate Cancer

Michael J. Barry; Christopher M. Coley

doi:10.7326/0003-4819-127-8_Part_1-199710150-00031

Letters |15 October 1997

Early Detection of Prostate Cancer

Michael J. Barry, MD; Christopher M. Coley, MD

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IN RESPONSE:

The two preceding letters reflect the controversy over how aggressive clinicians should be in recommending for or against early detection efforts for prostate cancer, particularly with PSA determinations.

Dr. Ashley and Mr. Knuth argue that the predicted benefits of early detection of prostate cancer would be greater at any given age if healthier men with longer life expectancies were selected for screening. We agree. However, we do not agree that clinicians screen only healthy men for prostate cancer (particularly when “healthy” is defined as having no significant illnesses, normal results on basic laboratory tests, and not smoking), and no evidence is cited to support this assertion. In a 1995 nationwide survey of primary care physicians, for example, we found that 55%, 66%, 65%, and 58% of physicians, “almost always” perform routine PSA tests on men in their 50s, 60s, early 70s, and late 70s, respectively, despite the obvious fact that many of these men are being seen for medical problems [1]. Therefore, we believe that the life expectancies we used in our model, which represent an “average” burden of comorbidity, are appropriate for making policy decisions about screening. We agree, however, that clinicians should consider each man's age and health status when advising them individually about screening.

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Letters |15 October 1997

Early Detection of Prostate Cancer

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Letters |15 October 1997

Early Detection of Prostate Cancer

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