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Prostate cancer

Answers not so simple on prostate cancer test

One day you're supposed to get that prostate cancer test. The next day, maybe not. What's the best thing for your health?

Well, that depends.

On Monday, the government panel that sets recommendations for preventive medicine gave lukewarm reviews to the widely used PSA blood test for prostate cancer.

For younger men, there's not enough evidence to recommend getting the test, said the U.S. Preventive Services Task Force. And men age 75 and older definitely don't need it, the group said.

Here's a look at why the test is controversial:

What is PSA anyway?

It's prostate-specific antigen, a protein produced by the prostate gland. High PSA levels can mean cancer.

So why not just get the test?

The screening test can find aggressive cancers earlier, and that could save your life. But it also gives false positives. Only 25 percent to 30 percent of men with high PSA who have a needle biopsy — a procedure that can be painful — have prostate cancer.

There doesn't seem to be a lot of clarity here. Why not?

It's because doctors don't know the answers. Uncertainties surround prostate cancer. If you have a high PSA, you may not have cancer. If you have cancer, it often grows so slowly that you don't need to be treated. And if you need treatment, it's often unclear which one is best.

The test can set men on a path toward treatments that can have serious side effects, such as incontinence and impotence.

"Some men get treated just because they have a cancer, not because they need the cancer treated," said Dr. Julio Pow-Sang, chairman of genitourinary oncology at H. Lee Moffitt Cancer Center and Research Institute in Tampa.

"A large proportion of prostate cancers, perhaps even half, probably would never have caused any health problems," said Dr. Kenneth Lin, medical officer at the Agency for Healthcare Research and Quality. "Most men can't stand it. They get treatment (instead of watching the cancer). They get radiation, they get surgery, and then they have the problems that go with that treatment."

But isn't prostate cancer dangerous?

That's the flip side. Some prostate cancers are aggressive. They move rapidly and can kill. Nearly 220,000 U.S. men are diagnosed each year, and more than 27,000 die.

"Prostate cancer is a very slow-growing disease in most men — but not all men," said Dr. Johannes Vieweg, urology chairman at the University of Florida. "If it's your dad or my dad, statistics are sometimes misleading, because it's the patient who counts."

Treatment may be unpleasant, but it also saves lives, said Robert Smith, director of cancer screening for the American Cancer Society.

"It may very well be that the side effects are the cost of being alive,'' he said.

So how do I decide?

Generally, men who should consider the test are age 50 to 75. The task force says there's not enough evidence to say whether to get the test, even for men at high risk. The American Cancer Society says men should be "offered" the test each year starting at age 50, but that African-American men and men with a family history "should begin testing" at age 45.

That leaves a lot of men to decide on their own, or with their doctor. Some doctors, including Vieweg, advocate screening. Others don't.

"There are doctors who are well acquainted with the issues, and others who are not," Smith said. "I'm sure there are some doctors who tilt their answers in favor of testing, and others who don't."

In the end, the decision's up to you. Are you a worrier or a free-wheeler?

"Men who are really concerned and want to get the test, they should have the test," Lin said. "But then there are men who might say, 'Don't bother.' "

Does this mean men over 75 should never get tested?

Older men should still see their doctor if they have symptoms of prostate cancer, such as weak or painful urination. Chances are, they have another condition.

"They should seek treatment, but they shouldn't worry so much," Lin said.

Men over 75 can still get the test if they want one, Pow-Sang said.

"A 76-year-old man who's playing tennis, playing golf and he's very active and very conscientious about his care …the doctor has to respect his wishes," he said.

Where can I find out more?

For more about screening for prostate cancer:

For more about treatment: and look in the Spotlight column.

Lisa Greene can be reached at or (813) 226-3322.

Answers not so simple on prostate cancer test 08/05/08 [Last modified: Tuesday, August 5, 2008 10:26pm]
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