Problematic Prostatic Prediction-Reply

In Reply.—  Our recent article on detecting prostate cancer by routine screening should not be interpreted as a recommendation that such a program be instituted at this time. Our purpose was to show the approximate cost of such a program, the outcome in terms of stage of disease at diagnosis, and the positive predictive value of the digital examination. Under the present standard of medical care, over 70% of patients have advanced disease at the time of diagnosis, which strongly suggests that current methods for identifying patients with localized disease are grossly inadequate. Our study shows that an increased suspicion for early cancer combined with an inexpensive and sensitive aspiration biopsy can result in diagnosing a higher percentage of patients with potentially curable prostate cancer. We expect that this will result in a higher sensitivity than the 69% rate reported by Guinan et al,¹ but at a cost of