To the Editor.
—Dr Jacobsen and colleagues1 describe secular changes that have occurred since the introduction of serum PSA testing. Not cited in their article was our earlier study2 that showed a greater than twofold increase in the number of newly diagnosed prostate cancers in a period in which PSA screening increased nearly sevenfold in our institution. We further showed that the increase in detection of prostate cancers was not associated with any decrease in the average Gleason scores of diagnosed tumors. From this, we suggested that PSA screening does not selectively detect indolent cancers.