PSA Screening and Prostate Cancer Incidence

George G. Rhoads, MD, MPH; Orlando F. Mills, MD
JAMA. 1996;275(15):1155. doi:10.1001/jama.1996.03530390021014.
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To the Editor.  —The report by Dr Jacobsen and colleagues1 on the changing incidence of prostate cancer with the introduction of prostate-specific antigen (PSA) screening may lead the unwary reader to conclude that there are early signs that screening will reduce prostate cancer morbidity and mortality. The article contains no indication that this is the case. It is well known that many older men have occult prostate cancer and that serum PSA is elevated in at least some patients with organ-confined disease. Given widespread PSA screening, it would be surprising not to find an increase in incidence, especially of cases in early stages.The authors' assertion that this increase should be transient warrants comment. If an active screening program leads to the identification of an increased proportion of many small prostate cancers that are known to be present at autopsy, a long-term elevation in observed incidence should be expected


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