Routine Prostate Cancer Screening Doesn't Reduce Risk of Death

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Screening Has Potential Pitfalls

"The test is far from perfect, there are many false positives because of other conditions that can elevate PSA levels, such as an enlarged prostate," said Dr. David Penson, director of urologic surgery at Vanderbilt University Medical Center. "That can lead to a cascade of events -- prostate biopsies are not comfortable and carry a risk of infection and a small risk of dying. "

Penson also said there are a fair number of overdiagnosed tumors, and people may have an inactive cancer that doesn't require aggressive treatment.

Since there are no good tools to determine whether someone's prostate cancer is an aggressive form or not, men opt for treatment such as radiation or surgery, which can also have numerous complications.

"But the benefit is that if you happen to catch a moderate or high-grade cancer early, it can be treated and kept in remission," Penson said.

Despite the arguments against routine PSA testing, it's exactly that benefit that Dr. William Catalona emphasizes when he voices his strong support for regular screening for many men.

"There's been a 40 percent decrease in the death rate from prostate cancer in the U.S. and if PSA screenings are stopped, it would push back the progress that's been made," said Catalona, professor of urology at Northwestern University's Feinberg School of Medicine. "I don't think every person should be screened, but my general feelings are that men should start PSA testing in their 40s just to get some data to look at, and if it starts to rise and show a trend, they need to make individual decisions about treatment."

He also criticized the PLCO study as well as the studies he said the U.S. Preventive Services Task Force used to make their recommendations.

"They took flawed studies and combined them with better studies, and the results from the flawed studies diluted the benefits of the good ones."

While experts continue the back-and-forth discussion on prostate cancer screening, Andriole said he and his team plan to continue tracking the participants for a couple more years. He also said he hopes to work with European researchers to pool their analyses.

Brooks hopes that ultimately there will be tools other than the PSA test available.

"We need better tools for screening -- we need tools to ascertain more clearly what cancers are going to be the fast-growers and likely to cause more harm," he said.

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