PSA Testing: What Should Men Do?

Fallout from 2 studies, pro and con, has experts in a quandry

By Ed Edelson
HealthDay Reporter

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THURSDAY, March 19 (HealthDay News) -- In the wake of yesterday's publication of two major studies on the prostate-specific antigen (PSA) test to detect prostate cancer -- one finding that it didn't save lives and another finding that it did -- American men may be wondering if the test is still worth taking.

The studies, published in the New England Journal of Medicine, probably won't end the long controversy surrounding a blood test that millions of men have routinely been taking for years.

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While an elevated PSA reading may indicate a life-threatening cancer, it may also detect much slower moving tumors that would never cause death. Because doctors cannot yet tell the difference, treatments are often ordered that can impair men's quality of life -- causing many experts to worry that the PSA test is overused.

The American Cancer Society, for one, does not currently recommend routine PSA screening for all men.

"We stopped mentioning screening in 1997, and since then have been for 'informed decision-making,'" said Dr. Otis Brawley, chief medical officer of the society. "We recommend that the physician should offer the test and inform men of the potential risk and potential benefit of screening."

One of the NEJM studies, which followed almost 80,000 American men for seven years, found no reduction in prostate cancer deaths among those who had regular PSA tests, compared to men who made no special attempt to have such tests. But the other study, which included 182,000 European men, found a 20 percent lowering of prostate cancer deaths among men who had such screening.

"At least initially, these won't change our recommendations," said the ACS' Brawley. However, "we will get our prostate cancer advisory committee together to consider the issue," he added.

According to Brawley, men at higher risk of prostate cancer, such as those with a family history and African-Americans, should have that conversation with a physician at age 45, while most men can wait until age 50.

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