Value found in PSA test for prostate cancer

In the latest salvo in a medical dispute that has confused both patients and doctors, a new study is defending the beleaguered PSA test for prostate cancer ? a test that a government advisory panel earlier this year said shouldn't be used as a screening tool.

The study, published Thursday in the Journal of Urology, finds the rate of prostate cancer deaths has fallen by 44 percent since the PSA test became routinely offered by doctors in 1990. In addition, the death rates for African American men ? traditionally much higher than for whites ? are now almost the same.

?The evidence is pretty compelling that if we did not have PSA testing today, there would be 20,000 to 30,000 more men in the United States each year that would be dying of prostate cancer,? said Dr. Ian Thompson, senior author of the study and director of the Cancer Therapy and Research Center at the University of Texas Health Science Center.

That conclusion differs from that of the U.S. Preventive Services Task Force, which in May recommended that PSA tests not be used to screen healthy men for prostate cancer. The recommendation was based on another large study that found it didn't save lives. Although the PSA test finds more tumors, they tend to be slow-growing and unlikely to kill, the task force said. Treating those can lead to lifelong side effects ranging from impotence to incontinence.

Some groups, including the American Urological Association, disagreed with the task force's conclusions, arguing that some men would benefit from PSA screening and that its use should be discussed by doctors and patients.

Thompson and his colleagues based their conclusions on three large prostate cancer studies done before and after 1990, when the PSA test began being routinely offered as part of a routine check-up. He said that although PSA isn't the only reason for the drop in death rates, it definitely played a role.

All three studies, which included thousands of men across the country including some in San Antonio, looked at survival rates after treatment that starves prostate tumors of the hormone testosterone.

?I think there needs to be common ground between what the U.S. Preventive Services Task Force has to say and people with more aggressive approaches to screening,? said Dr. David Crawford, head of urologic oncology at the University of Colorado, Denver, who didn't take part in Thompson's study.

Crawford led another large study on the value of screening. He said it's clear that many small cancers don't require treatment. ?You need to separate diagnosis from treatment. I don't think you should throw screening away, but use it selectively.?

Thompson said he worries the controversy means busy doctors aren't even discussing screening with their patients, much less offering the choice to those at high risk. Before PSA, men often came in ravaged by massive amounts of cancer. Since then, advanced cases are diagnosed early and are far more treatable.

?I don't think I'd be alive today if it wasn't for the PSA test,? said Roosevelt Davis, 71, an African American retired lab technician whose prostate cancer was diagnosed and treated with surgery a decade ago. It was found after a routine physical required before he took up skydiving. ?I've got two sons, one in Oklahoma City and one in San Antonio. I told them both, 'Get the PSA test and send Dad the bill.'?

dfinley@express-news.net

Source: http://www.mysanantonio.com/news/local_news/article/Value-found-in-PSA-test-for-prostate-cancer-3811034.php

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