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Michael E. Stuart, MD; Matthew R Handley, MD; Michael R. Conger, MD
Group Health Cooperative of Puget Sound Seattle, Wash

JAMA. 1992;268(22):3197-3198.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—We would like to comment on the Editorial by Oesterling¹ regarding PSA testing. Oesterling, in recommending PSA testing and surgery, appears to assume that all prostate cancers discovered by PSA testing will act in a malignant fashion and require surgery. This assumption needs to be addressed.

First, autopsy studies have demonstrated that many or most cases of prostatic carcinoma are latent or indolent. The incidence of prostate cancer increases from 30% in the fifth decade to close to 100% in men over the age of 90 years. In contrast to this increasing incidence, the cumulative lifetime risk for death is only 2.5%,² and the average 5-year age-specific prostate cancer mortality in men aged 50 through 74 years never exceeds 0.14%.³ There are currently no data to show that PSA testing differentiates between indolent and aggressive cancers. Screening for cancer of the prostate will likely . . . [Full Text PDF of this Article]

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