Prostate cancer poses some of the most vexing questions in medicine, and one out of every six men in the U.S. will confront them at some point in his life.
Two big studies in the New England Journal of Medicine found that screening for PSA--prostate specific antigen--doesn't save many lives. Should you keep checking it?
PSA testing revolutionized detection of the disease in the late 1980s. But PSA screening can flag tumors almost too early, leading to unnecessary surgery or radiation. Of the 185,000 U.S. men diagnosed with the disease each year, an estimated 85% would likely die of something else long before their cancer caused problems. Other prostate cancers are aggressive, each year killing some 28,000 men in the U.S. who weren't treated in time. That makes it the second most deadly cancer in men, after lung cancer. As of now, it's difficult to tell in a cancer's early stage which patients have which kind of tumor.
Another problem with screening is that PSA levels fluctuate for many reasons, sometimes sending false alarms. A PSA level is cause for concern if it's higher than usual for the man's age or rising rapidly. If so, the next step is usually a biopsy.
Most doctors believe that men over 40 with a family history of prostate cancer should have annual PSA testing, along with African-American men, for whom the death rate from prostate cancer is twice as high as for whites. For others, "you probably don't have to get it tested every year," says Al Barqawi, a urologist at the University of Colorado Health Sciences Center. "If there's a change, then do it more often."
Source: Health Journal, The Wall Street Journal, March 31, 2009
Prostate cancer poses some of the most vexing questions in medicine, and one out of every six men in the U.S. will confront them at some point in his life.
Two big studies in the New England Journal of Medicine found that screening for PSA--prostate specific antigen--doesn't save many lives. Should you keep checking it?
Another problem with screening is that PSA levels fluctuate for many reasons, sometimes sending false alarms. A PSA level is cause for concern if it's higher than usual for the man's age or rising rapidly. If so, the next step is usually a biopsy.
Most doctors believe that men over 40 with a family history of prostate cancer should have annual PSA testing, along with African-American men, for whom the death rate from prostate cancer is twice as high as for whites. For others, "you probably don't have to get it tested every year," says Al Barqawi, a urologist at the University of Colorado Health Sciences Center. "If there's a change, then do it more often."
Source: Health Journal, The Wall Street Journal, March 31, 2009