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PSA Testing: What Should Men Do?
Date:3/19/2009

f prostate cancer, such as those with a family history and African-Americans, should have that conversation with a physician at age 45, while most men can wait until age 50.

African-American men have a higher incidence of prostate cancer and a higher risk of dying of the malignancy.

But Dr. Judd Moul, director of the Duke University Prostate Center, sees flaws in the U.S. study (which argued against a mortality benefit) that he believes invalidate its findings.

"In the American study, the control group was under routine medical care, and in that control group, half the men had PSA screening," Moul said. "So, it was screening versus 'semi'-screening."

In addition, there was no provision in the American study that men with high PSA levels should seek treatment, Moul said. "It's not a screening test if it isn't followed up with treatment," he said.

Moul has an admittedly personal interest in the subject, since his father-in-law died of prostate cancer. And, he said, he has vivid memories of the pre-PSA-test era, when most men with the disease were only diagnosed at an advanced, tough-to-treat stage.

"I don't want to go back to the days when I had patients all over the ward dying of painful metastatic prostate cancer," Moul said.

And so, he prefers the recommendation of the National Comprehensive Cancer Network, formed by major U.S. cancer centers, that all men have an initial PSA test at age 40, which would indicate their risk of developing prostate cancer, with follow-up testing at age 45. "After age 50, I would follow the recommendation of the American Cancer Society," Moul said.

And PSA testing should certainly stop at age 70, said Dr. Derek Raghavan, chairman of the Cleveland Clinic's Taussig Cancer Institute -- but with one caveat. If previous annual tests have shown a rising level of PSA, a protein produced by the prostate, testing should continue, Raghavan said.

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