First do no harm?

While we are very supportive of family physicians’ important role in “helping patients with localized prostate cancer reach treatment decisions,”1 we think it is just as important that family doctors attempt to ensure that as few men as possible are made to face this decision. Neither Birnie and Robinson’s clinical review1 nor Ladouceur’s accompanying editorial2 appear to address or acknowledge the fact that one of the most effective ways to avoid this clinical dilemma is simply to not use or recommend unproven cancer screening techniques—thus allowing men with asymptomatic localized prostate cancer to remain rightly unidentified.

The clinical scenario at the beginning of Birnie and Robinson’s review mentions that the patient was “sent to a urologist because of elevated prostate-specific antigen levels and abnormal findings from digital rectal examination.”1 It is not clear why either of these examinations were carried out given that neither is recommended for asymptomatic men.3 Is it not possible that had this physician followed current prostate cancer screening recommendations, he or she would have avoided needing to help this patient with localized prostate cancer reach a treatment decision? Even more important, this patient could have also avoided being placed in this stressful circumstance!

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