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New Prostate Cancer Guidelines Aim to Empower the Patient
Date:3/5/2010

Diagnostic test not infallible, can lead to unneeded treatments with unwanted side effects

FRIDAY, March 5 (HealthDay News) -- New American Cancer Society guidelines on prostate cancer screening mean that many men will be faced with a cascade of decisions, with a growing responsibility for those decisions falling on their shoulders.

The guidelines, issued Wednesday, de-emphasize routine prostate-specific antigen (PSA) testing and re-emphasize the need for patient-doctor discussions on whether such tests are appropriate for individual patients.

PSA tests, which measure levels of a protein called prostate-specific antigen that's produced by the prostate gland, do detect cancers. But, they can make the situation worse by revealing malignancies that wouldn't cause a problem over a man's lifetime, leading to unnecessary treatments and undesirable side effects, such as urinary incontinence and impotence.

The new guidelines acknowledge the uncertainties surrounding PSA tests, which have been controversial for some time because assorted studies have produced conflicting results about the value of the screenings.

Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, found himself in a similar situation recently. Although he is of a generation where routine PSA testing is basically a reflexive practice, he was jarred when his PSA levels, after long years of quiescence, rose dramatically.

Thinking it might be an infection, his doctors prescribed antibiotics. A month or so later, the levels had come down, but not to their prior low point. Lichtenfeld was supposed to go for another test six months later.

"I just didn't do it. I found myself conflicted about the value of getting that follow-up test," he said. "I waited a year, and I had anxiety about it."

Fortunately, at the end of that year, Lichtenfeld's PSA levels had returned to their baseline and he wasn't
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