Screening for Prostate Cancer-Reply

In Reply.  —Dr Ruffin and colleagues raise several important points. First, they are correct to emphasize that physicians should disclose the uncertainty of screening, that DRE has no more supportive evidence than PSA or TRUS, and that recommendations to screen by the ACS and American Urological Association may represent a conflict of interest.However, I strongly disagree that Dr Krahn and colleagues¹ conclusively proved that prostate cancers creates more burden than benefit. Although the inclusion of a sensitivity analysis does show that the results of the study are consistent over a range of assumptions, the authors made no attempt to perform a multivariable sensitivity analysis, which might have significantly affected the conclusions. Even more importantly, there is no possible way to conclude from this study that screening more than once would not lead to a greater benefit. Recent studies of repeat screening have shown that patients with one normal