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The reply:

      We agree that the positive results of the Holmberg trial (
      • Holmberg L.
      • Bill-Axelson A.
      • Helgesen F.
      • et al.
      and the Scandinavian Prostatic Cancer Group Study Number 4. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer.
      ) do not apply to persons with screening-detected prostate cancer, for whom therapy may have a lower effect or even none at all. We also agree that the lack of an overall mortality effect is an important feature of the trial’s results. We did not elaborate on the results of therapy in part to emphasize our main point, which is totally independent of whether one believes therapy has any benefit for screening-detected prostate cancer—i.e., multiple forces in the decision-making environment push toward aggressive decisions for both screening and therapy and toward a perception of benefit, independent of whether there is any actual benefit. We agree with the writers and others that there are no data to demonstrate the benefit of prostate cancer screening among asymptomatic persons (

      Screening for prostate cancer: recommendation and rationale. Ann Intern Med. 2002;137:915–916

      ,
      • Harris R.
      • Lohr K.N.
      Screening for prostate cancer an update of the evidence for the U.S. Preventive Services Task Force.
      ).

      References

        • Holmberg L.
        • Bill-Axelson A.
        • Helgesen F.
        • et al.
        and the Scandinavian Prostatic Cancer Group Study Number 4. A randomized trial comparing radical prostatectomy with watchful waiting in early prostate cancer.
        N Engl J Med. 2002; 347: 781-789
      1. Screening for prostate cancer: recommendation and rationale. Ann Intern Med. 2002;137:915–916

        • Harris R.
        • Lohr K.N.
        Screening for prostate cancer.
        Ann Intern Med. 2002; 137: 917-929