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Prostate cancer screening: Why can't doctors agree?

By Delords - Tuesday, July 31, 2012

( -- If you're wondering why experts still can't agree on prostate-cancer screening, you're not alone.
Just two months ago, a major U.S. government panel said thatbasically no one should get screened for prostate cancer, claiming the simple blood test for prostate-specific antigen, or PSA, does more harm than good.
Now, a new study looks at government data and finds that, without PSA testing, the U.S. would have three times as many patients each year diagnosed with advanced-stage prostate cancer — and the vast majority of those cases would be fatal.
"Almost all men with clinically apparent metastases at initial diagnosis will die from prostate cancer," urologist and study author Edward Messing told reporters, as he explained the importance of his study.
The new study reflects a broader divide in the medical community, between public health experts who have largely turned away from PSA screening, and many practicing clinicians who feel the test has helped their patients immensely. Prostate cancer screening: Men should forgo PSA testing, panel advises
No one denies that PSA tests can help to catch prostate cancer early. But two issues are still unresolved. One is how well screening can actually work to prevent cancer deaths; the other is what kind ofnegative effects screening brings along with its benefits.
On the first issue, there is still some uncertainty. In the U.S., a large randomized trial found no mortality benefit of screening. But an even larger randomized clinical trial in Europe has found a benefit. In itslatest results published this spring, the European study team said that men who undergo routine testing have significantly lower risk of prostate-cancer death after 11 years.
Prostate cancer screening's false promise
The same European trial that found lower cancer mortality with PSA testing also found that, to save just one life through screening, an extra 37 men would need to be diagnosed with prostate cancer and treated. Many health experts think that's too much risky treatment to justify the results.Then, if the patient does have cancer, the available treatments for it — surgery, radiation, as well as other options — also have side effects, chief among them impotence, incontinence, and urinary incontinence.
Value of mass prostate screenings questioned
So when the government advisory panel — the U.S. Preventive Services Task Force — recommends against routine PSA testing, it's making a judgment call. It's saying that, for most men, the (albeit small) risk of sexual dysfunction and urinary leakage from eventual treatment is not worth it, given the even smaller chance that PSA testing could save your life. But that decision does remain a judgment call. It depends on how much you value certain quality-of-life measures versus how much you value having any life at all.

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