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Vital Signs

 
Summer 2009

Prostate Cancer: To Test or Not to Test?

06/17/2009

UCLA Health Vital Signs publication Summer 2009 issue: Prostate Cancer: To Test or Not to Test?That remains the question as two major studies offer mixed results about the efficacy of routine screening.

Two long-awaited studies in the United States and Europe to determine whether routine screening for prostate cancer is effective in saving lives have been released, with mixed results. They are the first to be based on large, randomized populations of men, who were followed for seven to 10 years. Both studies of the widespread prostate-specific antigen (PSA) test, which measures levels in the blood of a protein that is produced by the prostate and elevated in the presence of cancer, were published in The New England Journal of Medicine.

The American study suggested that routine screening does not lead to a reduction in deaths from prostate cancer and may, in fact, put many men at risk for unnecessary followup tests, treatments and negative side effects. The European study reported a 20-percent reduction in deaths among men who received PSA screening.

Robert Reiter, MD, Director of the Prostate Cancer Treatment Program at UCLA and Professor of Urology.Professor of Urology Robert Reiter, M.D., director of the Prostate Cancer Treatment Program at UCLA, says the European study, at least, “clearly demonstrated the benefit of screening.” But the question still remains open, says Mark S. Litwin, M.D., professor of urology and health services in the David Geffen School of Medicine at UCLA and the UCLA School of Public Health. “Basically, what the two studies show is that if you are screened regularly, you’re more likely to be diagnosed with prostate cancer, but the question of whether you are less likely to die from prostate cancer is a lot less clear,” he says.

The reason is that prostate cancer generally grows very slowly, and for a large percentage of men who are diagnosed late in their lives it may never become a threat — they ultimately will die from some other cause. And with faster-growing cancers even early diagnosis might be too late. But after receiving a diagnosis of cancer, many of these men may choose to have treatments such as surgery or radiation therapy that can lead to problems with urinary, sexual or bowel function. According to the findings of the study, to save just one life, nearly 50 men must undergo treatment that is unnecessary.

Thus, “the controversy is about the concept of over-diagnosis or over-treatment,” Dr. Reiter says. “Like many treatments for many diseases, treatment for prostate cancer can have complications. And so the question is: What is the benefit versus the risk that the average man may get from treatment?”

Though the findings of the studies were less than definitive, many physicians still believe that the PSA is a valuable test. “If used properly, PSA screening is an excellent test to detect cancer and can help the doctor and the patient choose the best form of therapy, or whether therapy at all is the right thing to do,” Dr. Reiter says.

Mark S. Litwin, MD, professor of urology and health services in the David Geffen Schoolof Medicine at UCLA and the UCLA School of Public HealthFor younger men, particularly if they are in a high-risk group — they have a family history of prostate cancer or are African American — PSA screening does make sense, according to Dr. Litwin. “If you find out at age 48 that you have prostate cancer, it probably does make a difference in terms of your decision-making and long-term survival,” he says. “If there’s any group for whom at least a baseline screening makes sense, that would be for younger men.”

Ultimately, the physicians say, the decision whether or not to be screened is a personal one, to be made in consultation with one’s own doctor. “Most urologists are attuned to the issue of screening, and they should be able to discuss these issues with their patients,” Dr. Reiter says. Adds Dr. Litwin: “Studies can give us valuable information, but when the patient is behind the exam-room door with his doctor, all the decisions that have to be made are very personal and are informed by that patient’s life experience.”

To read interviews with Drs. Litwin and Reiter on the issue of PSA screening and treatment for prostate cancer, go to:

www.uclahealth.org/QA-Litwin
www.uclahealth.org/QA-Reiter





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