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Joseph E. Oesterling, MD
Mayo Clinic Rochester, Minn

JAMA. 1992;268(22):3199.

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

In Reply.

—The above Letters to the Editor touch on many important issues that I will address in the following comments.

The prevalence of incidental, clinically insignificant prostate cancer is undoubtedly quite high; the overall estimated value for men 50 years of age or older is 30% to 40%.¹ These are microscopic lesions that most physicians would argue are not of clinical importance, and thus, do not need to be identified or treated. However, neither PSA testing, DRE, nor transrectal ultrasonography (TRUS) possess the sensitivity to detect such small, clinically insignificant lesions. Depending on the series, 38% to 45% of patients with organ-confined prostate cancer—the ideal candidates for definitive treatment and the most likely ones to be cured—have a serum PSA value within the reference range.² Thus, with such low sensitivity, it is unlikely that the routine use of PSA testing will increase our detection rate of these . . . [Full Text PDF of this Article]

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