Screening through back passage as well as back door?

EDITOR—Donovan et al highlight the fact that current policy for testing amounts of prostate specific antigen (PSA) amounts to screening by the back door.1 They do, however, overlook another insidious form of screening by PSA. Men who present with the well known prostatic type symptoms in primary care typically receive PSA testing as part of their work up, either from their general practitioner or after referral. But these symptoms are not good markers for prostate cancer—in fact, men with obstructive urinary symptoms are no more likely than men without symptoms to have prostate cancer. In other words, in terms of prostate cancer, these men are asymptomatic.

To perform a PSA test in these men therefore amounts to screening, which seems to be overlooked by …