Prostate Tests Do More Harm Than Good

Men who receive a diagnosis of prostate cancer are faced with a frightening array of options.

To live with cancer might seem to be unthinkable, however, in light of the alternatives a slow growing cancer may be easier to live with than the side effects of cancer treatment and in the worse case, death from infection and other surgical complications.

Many men who agree to a PSA test do not understand what it is. Some common misconceptions:

— It shows cancer. In fact, PSA is just a measure of inflammation, and it can be elevated for many reasons besides cancer: normal enlargement of the prostate with age, an infection, even recent sex, a strenuous bike ride or horseback riding.

— It’s been proven to save lives. Only two large, well-done studies have looked at this, the task force says. The American study found annual screening did not lower the chances of dying of prostate cancer. However, cancer fear is so great, and belief in the value of screening so ingrained, that half the men assigned to the group not offered PSA tests got one anyway. That made comparisons to the group given annual screening difficult. For that reason, some doctors don’t believe the study’s conclusion.
The other study, conducted in Europe, found a small benefit for certain age groups screened every two to seven years — not annually. However, one Swedish center had such rosy results that scientists think it may have biased the whole study. If that center is excluded, no benefit from the PSA test is seen.

— The task force’s stance goes against past advice. Routine PSA testing has been supported by some advocacy groups and by urologists, the doctors who do the tests and treatments. But it has not been pushed by major scientific groups, the American Cancer Society or the government.

— It finds cancer early so you’re more likely to survive. About 90 percent of prostate cancers found through screening are early-stage. Most will grow so slowly they will never threaten a man’s life, but there’s no good way to tell which ones will. Research suggests that tumors causing symptoms are more likely to warrant treatment than those that are not. Also, finding aggressive prostate tumors early may not affect how lethal they prove to be; the PSA test may just let men learn of them sooner than they otherwise would.

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