Early this month, the United States Preventive Services Task Force recommended that men no longer receive a P.S.A. blood test to screen for prostate cancer because it doesn’t save men’s lives.
The recommendation set off a firestorm much the same way it did two years ago when the panel of private-sector experts in prevention and primary care recommended women in their 40s no longer get routine mammograms.
Local urologists disagree with the findings and said the new recommendation puts thousands of men in harm's way.
"These men will not be aware that they have prostate cancer until it's too late," said Dr. Mark Haber, managing partner with Georgia Urology. "Early detection is critical to the success of prostate cancer treatments."
While a subset of patients exists for whom prostate cancer is an indolent disease, the problem is differentiating these men from the tens of thousands for whom the disease can be fatal, said Dr. Thomas Emerson, managing physician of Urology Associates in Marietta.
Emerson credited the P.S. A. test, which measures tlevels of prostrate-specific antigen, a protein released by prostate cells, with a nearly 40 percent drop in prostate cancer mortality over the last two decades.
"This dramatic reduction in mortality during the P.S.A. era did not even garner a mention in the task force's report," he said.
So what's the best course of action?
To help you make up your mind, we asked Dr. Viraj Master, urologic oncologist at the Winship Cancer Institute and director of clinical research at Emory University’s Department of Urology, some questions on the issue.
Q. In your experience with this cancer, is this test saving men's lives?
A. P.S.A. testing certainly can save men's lives. On the other hand P.S.A. testing can also potentially harm a man unless there is a thoughtful conversation about the need for treatment versus screening.
Q. How is the P.S.A. used?
A. This test is used by a lot of different physicians for a variety of purposes. For example urologists use it after patients have been treated for prostate cancer to determine whether there has been recurrence. On the other hand, an internist might use it as part of a battery of tests in screening a patient's health status.
Q. I understand that part of the problem with the test is it doesn't help distinguish between low and high risk. Is that right?
A. The P.S.A. test can rule in prostate cancer when the P.S.A. level is exceedingly high such as 50. However, most men don't present with prostate cancer in that fashion. Most men present with a P.S.A. somewhat less than 10, or even lower.
Q. Even if the test isn't perfect, how can it hurt?
A. It's where we act on information that the test may or may not be telling us, which can lead to the recommendation for a prostate biopsy. Then a prostate biopsy, if cancer is found, may lead to a patient being referred for active treatment. Both biopsy as well as active treatment has a number of side effects such as a biopsy producing infections or bleeding. Treatment itself can produce on occasion impotence, incontinence and a number of other side effects.
Q. So when should a men have a P.S.A. test?
A. That's the subject of active investigation and the data still remains to be further analyzed. The American Urological Association recommends men get a test at age 40 but if low, a retest can be deferred for a period of time. The American Cancer Society recommends a discussion about the pros and cons of screening at age 50 in most of the population or age 45 in African-American men or age 40 in patients with multiple family members with prostate cancer or deemed at high risk for prostate cancer.
Q. What are the pros and cons to having the test?
A. The pro is that a life-threatening cancer can be diagnosed in many cases. The con is most prostate cancers do not represent an urgent threat to a person's life but are often treated.
Q. I understand the evidence on which this recommendation is based was obtained from studies with participants who were overwhelmingly Caucasian. Should black and other minorities still be tested?
A. In the current era with the information we have, yes. The need is vital for African-American men and other men of color to participate in clinical trials to study this issue.
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