Response: Re: Prostate-Specific Antigen Testing among the Elderly in Community-Based Family Medicine Practices

To the Editor: I appreciate Dr. Teichman's interest and response¹ to our article on prostate cancer screening in the elderly.² I agree with his assessment of thoughtless practice and its potential harms. After this article went to print, initial results from the Prostate, Lung, Colorectal and Ovarian Cancer (PLCO) Screening trial were published and provide additional support for our concern that aggressive prostate cancer screening and treatment for the elderly is not effective, patient centered, or efficient. In the PLCO trial, Andriole et al³ found that prostate cancer screening provided no reduction in death rates at 7 years and that two-thirds of study participants reported no screening benefit at 10 years of follow-up. They, therefore, concluded that their results support the validity of the US Preventive Services Task Force recommendations against screening men over 75 years of age. Consequences of overdiagnosis and overtreatment are not insignificant for either patients or clinical practice.⁴ The question regarding family medicine's leadership role in the informed or shared decision making conversation is an important issue that needs to be addressed.