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Screening for Prostate Cancer-Reply

Murray D. Krahn, MD, MSc; John E. Mahoney, MD; Allan S. Detsky, MD, PhD; John Trachtenberg, MD; Mark H. Eckman, MD; Stephen G. Pauker, MD
JAMA. 1995;273(15):1175-1176. doi:10.1001/jama.1995.03520390031022.
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In Reply.  —For screening to be a rational strategy, patients identified as having prostate cancer must, on average, have better outcomes than patients not identified by screening. Because such benefit has not yet been demonstrated by any randomized trial, clinicians and patients must use the best information at hand to make their personal decisions. Dr Miles and colleagues suggest that the study by Johannson et al1 may not be the best data on patients with early, untreated prostate cancer because that study may provide an overly optimistic view of natural history. In fact, the distribution of tumor grades and the cause-specific survival rates by grade in that study are similar to those reported by Chodak et al2: Johannson et al reported the proportion of grade 1, 2, and 3 tumors as 0.66, 0.30, and 0.04, respectively, whereas the meta-analysis of Chodak et al reported 0.60,0.32, and 0.08, respectively;

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