Men Not Being Told Enough About PSA Tests

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"This is a very important decision. We think it should be an informed or shared decision, and it's not happening," he said.

The problem with getting the test is that a positive result is going to lead to a biopsy, and only one out of four men who have a biopsy have cancer, Hoffman said.

One reason these discussions aren't taking place is that doctors don't have enough time to discuss screening and prostate cancer in general with their patients, Hoffman said.

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Men should educate themselves about the pros and cons of PSA testing, Hoffman said. There are various aids for making such a decision both on the Internet and in print, he said.

In the second report, Kirsten Howard, a senior lecturer in health economics at the University of Sydney in Australia, and colleagues created a statistical model, based on family history, to provide information for men who have low, moderate and high risk for prostate cancer.

"The results of the model predict that benefits and harms of annual PSA screening vary with age and risk level," Howard said.

For example, screening 1,000 men every year from age 40 to 69 only reduces the number who will die from prostate cancer by age 85 from 30 to 28, Howard said.

"So instead of 30 out of the thousand dying from prostate cancer by age 85, only 28 will die of prostate cancer. By the time they are 85, about 640 will have died from all causes of death whether they were screened or not," she said. "Higher risk men have more prostate cancer deaths averted, but also more prostate cancer diagnosed and related harms."

From the model, screened men are about two to four times more likely to be diagnosed with prostate cancer than men who do not get the screening, but death rates from prostate cancer and from other causes are similar in both groups, Howard said.

"The net mortality benefit is small, and this needs to be weighed against the increased chances of being diagnosed and treated for prostate cancer," she said. "Before undergoing PSA screening, men should be aware of the possible benefits and harms, and of their chances of these benefits and harms occurring."

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