Dr. Albertson has been a leader in delineating the natural history of prostate cancer and warning us about overdetection and treatment. This review article 1 Albertsen PC. The unintended burden of increased prostate cancer detection associated with prostate cancer detection associated with prostate cancer screening and diagnosis. Urology, in press. Google Scholar enhances this reputation; it is complete and clearly written. He reminds us again that we are picking up too much prostate cancer, we are treating too many of them at significant morbidities, and although the death rate is declining in many western countries and the best controlled randomized trial (ie, the European ESRPC) suggests survival benefit, there is an alarmingly high rate of overdiagnosis. One estimate suggests that almost 1500 cases need to be screened for 50 cancers to be detected to cure 1 man. It is no wonder that the U.S. Preventive Task Force (References 5 Lange P.H. A philosophical reflection on PSA screening What should we now think and do. in: Thomsan I.A. Resnick M.I. Klein E.A. Prostate Cancer Screening. Humana Press, Totowa, NJ2001: 97-104 Crossref Google Scholar and 6 Lange P.H. Schellhammer P.F. Views from the “other side”: personal reflections about prostate cancer from two urological oncologists. in: Kirby R. Partin A.W. Feneley M. Prostate Cancer: Principles and Practice. 2006: 617-624 Google Scholar in the article) and maybe the American Cancer Society 2 American Cancer SocietyProstate Cancer Screening Recommendation. http://www.cancer.org/docroot/ped/content/ped_2_3x_acs_cancer_detection_guidelines_36.asp Google Scholar are going on record against widespread early detection and all concerned organizations recommend careful education of the patient before testing. Yet we all know that a true orientation can be time prohibitive and much of the time these men say, “what would you do and what do you recommend I do?” 3 Smith Jr, J.A. What would you do, doctor?. J Urol. 2009; 182: 421-422 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar The Unintended Burden of Increased Prostate Cancer Detection Associated With Prostate Cancer Screening and DiagnosisUrologyVol. 75Issue 2PreviewThe increasing incidence of prostate cancer is associated with the intensity of screening for prostate-specific antigen. Although some men may benefit from the early detection of prostate cancer through screening, all men diagnosed with prostate cancer experience an effect on their mental and physical well-being and that of their families. In light of the recent publication of the United States Preventive Services Task Force recommendations concerning prostate-specific antigen testing, this article reviews the quality-of-life implications of prostate cancer screening and diagnosis, and explores risk reduction in screened men as a potential strategy to manage these issues. Full-Text PDF ReplyUrologyVol. 75Issue 2PreviewI appreciate Dr. Lange's kind words and agree with his conclusions. We cannot embrace a “no screening” policy. The ERSPC study has shown that screening can reduce prostate cancer mortality within 8 years of diagnosis.1 Furthermore, this benefit may increase as we follow patients for a longer duration. There are major differences however, in the way PSA testing is practiced in the United States and that described in the ERSPC study. Full-Text PDF