To the Editor: The general practitioners’ dilemma is acute. Women asking for mammography and/or testing for ovarian cancer; men asking for prostate-specific antigen (PSA) testing for prostate cancer. The debate, fuelled by uncertain knowledge, rages in the general medical journals,1,2 including contributions in the 17 August 2009 issue of the MJA.3,4

The PSA test is, of course, intimately associated with the name of its inventor, Thomas A Stamey. I am, therefore, somewhat surprised that neither of these recent MJA articles mentioned Stamey’s 2004 “recanting” of his proposed value of the test back in 1987: “current evidence from the last 10 years is convincing that the relationship between prostate cancer and serum PSA is tenuous at best, especially with serum PSA less than 10 ng/mL and perhaps even less than 22 ng/mL. This time is not the first we have had second thoughts regarding the usefulness of serum PSA in preoperatively reflecting prostate cancer”. He concludes: “any excuse to biopsy the prostate has an excellent, age dependent chance of being positive”.5

Perhaps the authors could tell your readers why they did not think that Stamey’s 20-year experience of PSA testing and his 2004 conclusions warranted a mention?

In reply: The letter by Arnold highlights the practical dilemma facing busy doctors when communicating with patients about whether to screen for various cancers, prostate cancer in particular. There are no easy answers at present, although presentation of both sides of the argument regarding prostate cancer testing helps doctors and patients make a shared decision.1 We believe the following decision-aid show card, written in plain English, is an excellent resource to assist with this: <http://www.cancer.org.au/File/HealthProfessionals/GPprostateshowcard.pdf >.