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Men Can Still Ask for PSA Test, and Some Should, Doctors Say
Date:5/22/2012

other reliable screening test exists to detect prostate cancer.

Patients should discuss any concerns about testing -- or not testing -- with their doctor, experts said.

Dr. Otis Brawley, chief medical officer of the American Cancer Society, said better tests to determine not only the presence of prostate cancer but each case's true threat to patients have been held back from development because of the fixation on PSA testing. But Brawley and other experts said such future tests will likely focus on the specific genes at play in the malignancy.

"Truth be told, prostate cancer screening as a whole, and its progress, has been delayed because so many people have been adamant about doing PSA screening in the last 20 years and not assessing if it works," Brawley said.

Prasad called it "stunning" that imaging tests such as CT or MRI scans aren't often used to detect prostate cancer, as they are for many other malignancies.

"If we go back to diagnosing with symptoms ... it seems like a tremendous step backward," he said.

"Without the PSA, obviously we will diagnose fewer and fewer men," Prasad added. "But for the guys [in which] you pick it up five, seven or 10 years earlier, you can save their life. As physicians, we're called on to do that as best we can."

A better test will come, Brawley said, noting that "the science has advanced so much in the last five years."

Dr. Anthony D'Amico, chief of radiation oncology at Brigham and Women's Hospital in Boston, said pathology guidelines are needed that would better identify aggressive prostate cancers from less harmful versions.

"PSA diagnoses every cancer that walks, and not every prostate cancer that walks needs to be cured," he said. "The solution lies at the level of the pathologist... We need to sit down with them and come up with guidelines [about what constitutes high-grade prostate cancer]. It can be done, but it needs to be worked on."

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