Recommendations on Use of Prostate-Specific Antigen for Prostate Cancer Screening—Reply

In Reply: We agree with many of Dr Garnick's points. However, he appears to have overlooked our affirmation of the known harms associated with prostate cancer screening:

Garnick notes that the USPSTF concluded the “routine” use of PSA for prostate cancer screening should no longer be recommended. Had that indeed been the case, we would be in general agreement with the USPSTF's recommendation. But the critical point is that the USPSTF made a D recommendation—arguing there was moderate certainty that the harms of PSA-based screening outweigh the benefits and recommending against screening altogether. We suggested the evidence supports a C recommendation, wherein men would have the opportunity to make a decision about screening in consultation with their physician. This difference is not trivial because it affirms a physician's obligation to engage men in an informed decision-making process and provide the opportunity to make an individualized decision.