- The Washington Times - Monday, January 9, 2006

CHICAGO (AP) — Two widely used tests for prostate cancer failed to save lives in a new study, adding to the debate over whether men should be screened for the disease.

The researchers looked at two screening tests that are performed millions of times a year in the United States: a blood test that measures prostate-specific antigen, or PSA, and a digital rectal exam, the rubber-glove test in which a doctor feels for abnormalities in the prostate through the rectal wall.

Study co-author Dr. John Concato, a clinical epidemiologist at the Veterans Affairs Connecticut Healthcare System, said that, for now, doctors should tell men that screening tests for prostate cancer are not perfect, and men should decide for themselves whether to be screened.

In the study, published in yesterday’s Archives of Internal Medicine, researchers compared two groups of men treated at 10 Veterans Affairs medical centers.

One group consisted of 501 men who were diagnosed with prostate cancer and who later died of that disease or other causes. Researchers chose 501 men who matched the first group for age and other factors, but who survived.

The researchers found that the men who survived were no more likely to have been screened than the men who died of prostate cancer. The study was based on data from 1991 through 1999, the early years of PSA screening.

The findings support an earlier review by the U.S. Preventive Services Task Force. That agency said in 2002 that it found “insufficient evidence” for a recommendation that men be screened.

The American Cancer Society says men starting at age 50 should be informed of the risks and benefits of screening, then make their own decisions, but higher-risk men, including blacks, should be screened annually starting at age 45.

Doctors have long known that some cases of prostate cancer can be so slow-growing that they never cause symptoms, or death. In addition, surgery and radiation treatment for prostate cancer can cause incontinence and impotence. So for some men, detecting prostate cancer early through screening can do more harm than good.

In addition, the PSA tests can yield ambiguous results. Most men who undergo a biopsy because they have elevated PSA levels do not have prostate cancer. Some men with low PSA levels actually do have cancer, usually small, slow-growing cancers that would be detected by later PSA tests.

Medical organizations differ on their screening recommendations. But generally, most say men should be told the risks and benefits of screening first.

“We should tell patients about the uncertainty,” said Dr. Howard Parnes of the National Cancer Institute. “All too often, we behave as if we know screening is a good thing.”

The prostate is a gland the size of a walnut under the bladder that makes fluid for semen. Prostate cancer is second only to skin cancer in its prevalence among American men.

More than 232,000 U.S. men are expected to be diagnosed with it this year and about 30,000 will die of it. A diet high in fruits and vegetables may reduce the risk.

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