We strongly support Associate Professor Barendregt's suggestion of a more evidence-based approach to PSA screening in New Zealand (i.e. the use of PSA testing in asymptomatic men).1Screen-detected disease is often different to clinical disease: the simplistic idea that early detection by screening must save lives has been shown repeatedly to be illusory. The putative benefits of any screening test must be weighed against the serious harms screening can cause. The continued selective use of a minority of results from the six randomised studies of PSA testing, in order to prop up a position on the value of PSA testing in asymptomatic men by its advocates,2 is inappropriate.Lamb et al2 also refer to the Health Select Committee report for guidance in recommending what general practitioners should do in the care of their patients. This elevates the judgement of members of a parliamentary select committee to specialist medical opinion, which would be a novel approach for medical practice in New Zealand.Systematic evidence-based approaches continue to be unsupportive of PSA testing for asymptomatic men due to both the conflicting evidence regarding reduced prostate cancer mortality and the considerable iatrogenic illness caused from overdiagnosis and, therefore, overtreatment.Such overtreatment and its side effects represent a considerable waste of healthcare resources. Until results from additional well-conducted studies are forthcoming, more analysis of the available studies is most unlikely to resolve the issue. Brian Cox Associate Professor Mary Jane Sneyd Senior Research Fellow Hugh Adam Cancer Epidemiology Unit Department of Preventive and Social Medicine Dunedin School of Medicine University of Otago, Dunedin

We strongly support Associate Professor Barendregt's suggestion of a more evidence-based approach to PSA screening in New Zealand (i.e. the use of PSA testing in asymptomatic men).1Screen-detected disease is often different to clinical disease: the simplistic idea that early detection by screening must save lives has been shown repeatedly to be illusory. The putative benefits of any screening test must be weighed against the serious harms screening can cause. The continued selective use of a minority of results from the six randomised studies of PSA testing, in order to prop up a position on the value of PSA testing in asymptomatic men by its advocates,2 is inappropriate.Lamb et al2 also refer to the Health Select Committee report for guidance in recommending what general practitioners should do in the care of their patients. This elevates the judgement of members of a parliamentary select committee to specialist medical opinion, which would be a novel approach for medical practice in New Zealand.Systematic evidence-based approaches continue to be unsupportive of PSA testing for asymptomatic men due to both the conflicting evidence regarding reduced prostate cancer mortality and the considerable iatrogenic illness caused from overdiagnosis and, therefore, overtreatment.Such overtreatment and its side effects represent a considerable waste of healthcare resources. Until results from additional well-conducted studies are forthcoming, more analysis of the available studies is most unlikely to resolve the issue. Brian Cox Associate Professor Mary Jane Sneyd Senior Research Fellow Hugh Adam Cancer Epidemiology Unit Department of Preventive and Social Medicine Dunedin School of Medicine University of Otago, Dunedin