CORRESPONDENCE Prostate Cancer—

The median age of prostate cancer patients in the Nordic countries is 75 years (7). Usually, prostate tumors grow ex-tremely slowly. In autopsy studies, as many as 40 % of elderly men have a latent prostate cancer (2). This means that a high proportion of elderly men have a latent, small tumor that does not cause severe symptoms. How active should we be in diagnosing prostate cancer? During the last few years, this dilemma has inten-sified as a result of the increasing use of prostate-specific antigen (PSA) to search for an early diagnosis. For a long time (before the PSA epoch), it had been claimed that ur-ologists and other physicians in Den-mark have displayed an attitude in diagnosing prostate cancer different from that of many of their colleagues in the other Nordic countries. More than other groups, urologists and other physicians in Denmark have questioned the benefit of diagnosing tumors that do not cause local or general symptoms. Two reports (7 J) have presented data on the incidence of, survival with, and mortality from different types of cancer in the Nordic countries. The incidence of prostate cancer in the Nordic countries varies from 48.9 per 100 000 person-years (Denmark) to 85.0 (Ice-land). Compared with patients in the other Nordic countries, Danish prostate cancer patients have a poor prognosis, but only small differences exist between the Nordic countries regarding the mor-tality from prostate cancer. The explana-tion for this pattern may be that the other Nordic countries exhibit a higher diagnostic intensity in comparison with that seen in Denmark. If so, a large number of men have undergone need-less treatment, causing anxiety and dis-comfort. These three measures have differed between the countries for at least 20 years The numbers presented in Table 1 describe the situation before the epoch of PSA screening. The increase in in