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2 Studies Conflict Over Value of Prostate Cancer Screening
Date:3/18/2009

Doctors acknowledge that the PSA test is a far from perfect tool

WEDNESDAY, March 18 (HealthDay News) -- Two new studies offer conflicting views on the value of screening men with a prostate-specific antigen (PSA) test to check for prostate cancer.

But at least one leading oncologist says this much seems to be clear: A younger man with a strong family history of prostate cancer should pay attention to a PSA test, while an older man with known medical problems can probably avoid the exam.

That assessment comes from Dr. Gerald Andriole, chief urologic surgeon at the Washington University Siteman Cancer Center in St. Louis, and lead author of one of the two papers on major PSA screening trials being released Wednesday by the New England Journal of Medicine.

But the reports are far from the final word on the issue of PSA screening, because there's a significant debate on the subject among the experts who know the most about it. Uncertainty is the prevailing mood, as demonstrated by the journal's decision to avoid the customary authoritative "commentary" on the study results, and instead run the transcript of a debate on the issue with two authorities, replete with "ifs" and "buts."

Start with the study results. The American trial, funded by the U.S. National Cancer Institute, followed almost 77,000 men. Half were recommended to have annual PSA tests for six years and digital rectal exams for four years, while the other half was told to have their usual medical care.

While 22 percent more prostate cancers were diagnosed in seven years in the PSA group, there were actually more deaths from prostate cancer in that group than in the usual-care group -- 50 to 44. And there were more deaths overall in the PSA group -- some of them possibly attributable to overtreatment of the prostate cancers, Andriole said.

The European trial, which included 182,000 men, offered either a PSA test every f
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