Screening for Prostate Cancer

We commend Dr Krahn and colleagues for their outstanding decision analysis on screening for prostate cancer. They collected and effectively used available literature for a sophisticated Markov model analysis. Despite the use of an artificial one-time screening scenario, their evaluation avoids the bias evident in the accompanying Editorial. The authors provide recommendations regarding PSA and transrectal ultrasound (TRUS), but fail to address the role of DRE. Available literature provides no evidence supporting DRE as a screening test for prostate cancer or colorectal cancer. While the authors appear to include DRE in their conclusion “screening for prostate cancer cannot be justified as a rational health policy,”1 they leave DRE out of their recommendation that “asymptomatic men not be screened with PSA or TRUS.” Their data support not screening with DRE. The article and Editorial illustrate a difference between generalists' and specialists' approach to prostate.