The picture might become clearer as follow-up of the men in the U.S. study continues, Andriole said, because of the relatively limited follow-up time so far. "We just don't know what is going to happen to the youngest cohort of men in the study," he said. "We may see a benefit."
The message is clearest for older men, Andriole said. "If the man sitting in front of me is an elderly man with a limited life span, I can in good conscience tell that man that a PSA test is not necessary," he said.
There is a more complex message for younger men and their physicians, Andriole said. "I'm not confident we can tell younger men what to do," he said. "If they do have a digital rectal exam and a PSA test, then the physician's reaction needs to be less knee-jerk than it has been in the medical community so far -- to have a biopsy and the move directly to treatment if it is positive."
A PSA test measures levels of a protein produced by the prostate and thus is now cancer-specific, Andriole noted, and so, "if the results of this trial hold up, we may say that the PSA test is not a good indicator of prostate cancer."
Learn more about prostate cancer from the U.S. National Cancer Institute.
SOURCES: Gerald Andriole, M.D., chief urologic surgeon, Washington University Siteman Cancer Center, St. Louis; Edward P. Gelmann, M.D., professor, oncology, Columbia University Medical Center, New York City; Christine Berg, M.D., U.S. National Cancer Institute; March 26, 2009, New England Journal of Medicine
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