We thank Dr Braillon and Dr Dubois for their comments. We share their concern that the use of PSA screening leads to overdiagnosis. In the PLCO trial, we estimate that approximately 21% of the screen-detected prostate cancers were overdiagnosed, which was derived from the excess number of prostate cancers (n = 435) at 13 years of follow-up [Figure 2 in ( 1 )] among the number of screen-detected prostate cancers (n = 2049) [Table 2 in ( 2 )]. We also share their concern about detriments to quality of life, and in fact, an article on quality of life related to prostate screening in the PLCO trial is in preparation. We did not comment on the difference in stage IV cancers because like the higher mortality from prostate cancer, this was not statistically significant. We have provided the cumulative numbers of stage IV cancers in the intervention and control (usual care) arms ( Figure 1 ), as requested. Through 13 years, the occurrence of stage IV prostate cancer was non-statistically significantly lower in the intervention arm (relative risk = 0.87, 95% confidence interval = 0.66 to 1.14) compared with the control arm.

Figure 1

Cumulative number of clinical stage IV prostate cancers in the intervention and control arms from year 1 to year 13. C = control arm; I = intervention arm; PY = person-years.

Figure 1

Cumulative number of clinical stage IV prostate cancers in the intervention and control arms from year 1 to year 13. C = control arm; I = intervention arm; PY = person-years.

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