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Informed Consent for Tests for Prostate Cancer-Reply

Mark S. Litwin, MD, MPH
JAMA. 1995;274(2):128. doi:10.1001/jama.1995.03530020045024.
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In Reply.  —While Dr Marshall correctly points out the morbidity often associated with treatment for localized prostate cancer, he neglects a fundamental finding of our study: general healthrelated quality of life was not discernibly affected in these men, despite the pelvic dysfunctions they may have experienced.Informed decision making and shared responsibility are clearly the best ways for clinicians to guide patients through uncertain clinical choices. But Marshall's suggested informed consent for DRE and PSA testing would heavy-handedly push patients away from prostate evaluation. His detailed description of the risks, with mere lip service paid to the benefits, would be unfair to patients. As anyone who has lost a relative or friend to prostate cancer can attest, this disease can cause great disability, pain, and distress.1Our best defense against prostate cancer is probably early diagnosis. Despite a controversial literature, PSA has been proven highly accurate (91% specific and


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