New PSA Testing Recommendations Ignites Debate Again

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"I now explain to my male patients that we do not think in general that prostate screening will reduce the risk of death from prostate cancer in general," said Dr. John Messmer of the Penn State Hershey Medical Group in Palmyra, Penn. "But if the man is willing to accept that he might find he has an elevated PSA, and a biopsy shows cancer, it is not a straight line to surgery or radiation." Messmer said he discourages routine screening unless there are other risk factors for prostate cancer or patients are willing to accept the risks of testing.

Dr. Gerald Andriole, chief of urologic surgery at Washington University School of Medicine in St. Louis, said after discussing the risks and benefits of screening with his patients, many of them still opt for testing.

"They are worried about having prostate cancer and generally would prefer to have the test, knowing it is imperfect, than not getting tested at all. At least it gives them some information on which to make health decisions," he said.

Low-Risk Prostate Cancers May Not Require Treatment

"I understand about the reasons the USPSTF was concerned -- they were disturbed by the false positive results and overdiagnosis and overtreatment," said Scardino. "It's very important for people to know that many low-risk prostate cancers do not need to be treated. They can be monitored with little risk. Prostate cancer is not uniformly lethal."

An approach known as active surveillance involves monitoring low-risk cancers, but not treating them.

"Data to date suggest that with this approach we can identify the more aggressive, large cancers and still successfully treat them," said Andriole. "Active surveillance is apt to be better than early treatment with surgery or radiation therapy for many men with low-risk cancers and should lessen overtreatment."

Experts also agree that the development of better testing could someday provide a more definitive answer to questions about whether to perform routine screening.

Messmer explained there needs to be a better way to determine who needs treatment.

"We need genetic analysis of diagnosed prostate cancers to determine which ones will be fast growing and spread and which will not," he said.

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