The PSA Test Debate

In August a report came out which called into the question the effectiveness of frequent prostate cancer screenings. More from HealthDay News:
The researchers looked at more than 17,000 men who had prostate specific antigen (PSA) testing every two years or every four years. Among 4,202 Swedish men screened every two years, the overall incidence of prostate cancer diagnosis over 10 years was 13.14 percent, compared to 8.41 percent among the 13,301 Dutch men who were screened every four years, said the researchers from Erasmus Medical Centre in Rotterdam, The Netherlands.


The total number of interval cancers -- those diagnosed based on symptoms during the years between screening tests -- was 31 (0.74 percent) among the Swedish men and 57 (0.43 percent) among the Dutch men.

The differences in the interval cancer rates and aggressive interval cancer rates between the two groups were not statistically significant, the study authors said. This indicates that two-year screenings don't reduce the number of interval cancers, as might be expected.
So, I guess this tells us prostate screenings are “kinda” effective. Certainly contrary to this study contending that PSA testing is still “valuable.” Dennis Thompson of HealthDay News reports:
The cancer society recommends annual screenings for prostate cancer beginning at age 50 for most men, and at age 45 for men at high risk. Those at high risk include blacks and men who've had a close relative suffer from prostate cancer before age 65.


The screening involves two steps: undergoing a digital rectal exam and testing for PSA levels in the blood.

In the rectal exam, the doctor feels the prostate to see if there are any bumps or hard spots that might signify cancer.

And although PSA is not an indicator of cancer, but a protein created during inflammation of the prostate, doctors have found that highly elevated levels indicate an increased risk for cancer.

Studies now show that the regular testing of PSA levels can indicate cancer risk by showing rises or falls in the protein's levels.
And here’s one more side of the debate. Dr. Fuhrman isn’t sold on PSA tests. In fact, he believes they’re wrought with false confidence. Some of his thoughts:
Incredible as it may seem, the PSA test does not accurately detect cancer. If you are over 60 years old, the chance of having a prostate biopsy positive for cancer is high, and the likelihood you have prostate cancer is the same whether or not you have an elevated PSA. More and more studies in recent years have demonstrated that prostate cancer is found at the same high rate in those with lower, so-called “normal” PSAs as those with elevated PSAs.1 An interesting study from Stanford University in California showed that the ability of PSA to detect cancer from 1998 to 2003 was only 2 percent. The elevations in PSA (between 2 and 10) were related to benign enlargement of the prostate, not cancer.


Remember, the pharmaceutical/medical industry is big business. Too often, treatments are promoted from a financially-biased perspective, leading to overly invasive and aggressive care without documented benefits.

If you want to have your prostate biopsied, radiated, and cut out, go ahead, but you do not need a PSA blood test first to decide. The PSA test is just an excuse to give men a prostate biopsy.
Ultimately it’s your decision, but, all this will certainly have you scratching your head.
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DAVID - January 2, 2008 10:57 AM

There's a very good overview of prostate cancer statistics at this Google Answers link:

Prostate Cancer Survivability

http://answers.google.com/answers/threadview?id=531616

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