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PSA and the Detection of Prostate Cancer-Reply

William J. Catalona, MD
JAMA. 1994;271(3):192-193. doi:10.1001/jama.1994.03510270038023.
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In Reply.  —Most clinicians experienced in treating patients with prostate cancer would agree that routine prostate cancer screening in men over the age of 75 years is not beneficial. However, the hypothetical scenario created by Dr Robbins to demonstrate this point bears little resemblance to the real world. It illustrates why outcomes research cannot substitute for experienced clinical judgment.1First, the composition of Robbins' imaginary screening population (50% aged 75 to 79 years and 50% aged 80 years and older) does not comport with our experience and, in fact, is implausible. In our experience, approximately 20% of screening volunteers are over the age of 70 years, but less than 2% are octogenarians.2 Second, it is unlikely that any physician would advise every man over 75 years of age whose serum PSA level is above 4.0 μg/L to undergo biopsy or that one with clinical expertise would advise every


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