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Value of PSA Screening Questioned

Value of PSA Screening Questioned

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"As I know from my own experience, when a man goes for a PSA test or a woman for a mammogram, this is a very personal thing," Thornton tells WebMD. "A person applies the result to his or her own health. But a screening program is based on the attempt to produce a fall in mortality for the entire population. These programs don't stress the limitations, risks, or shortcomings of the test itself, or social and financial consequences that accrue from being screened. One goes into screening believing this has got to be a good thing -- after all, the medial profession is offering it to you. But you find it leads you into very tricky waters."

Most men believe that PSA screening will find cancers earlier and that early treatment will save lives, according to another paper in the same issue of the BMJ. Study leader Ann McPherson, MD, is a primary care doctor who also teaches at the University of Oxford, England.

"This is mainly a group of men who have prostate cancer," McPherson says. "They are most vociferous in saying prostate cancer screening should [be provided by U.K. medical services]."

McPherson lets her own patients know that the PSA test is available. But she tells them about the drawbacks as well as the possible benefits.

"First you need to know it is not a terribly good test in many ways," she says. "It is difficult to interpret the test. It certainly doesn't pick up all prostate cancers, so there is a problem with that. More important is that it diagnoses cancers that would never be very important, and you end up having many investigations and surgeries that aren't necessary."

But that's not the view of urologist Kenneth Ogan, MD, an assistant professor at Atlanta's Emory University School of Medicine.

"Numerous studies have looked at tumors removed after detection via PSA screening. Upwards of 95% of these have aggressive cancers in them," Ogan tells WebMD. "It makes sense to me that the downward trend in prostate-cancer mortality is from PSA screening. And I'm of the younger generation. You'd get a stronger vote for PSA screening from more experienced urologists who used to see people come in with much more advanced disease, where cure is impossible."

Like Ogan, Barry supports U.S. PSA screening recommendations. Like McPherson, he thinks patients should get full information on the risks as well as the benefits of screening.

"Men aged 45 and older with risk factors or family history of prostate cancer should no doubt avail themselves of PSA testing," Barry says. "Men should know about the risks and benefits of screening and that it is unclear whether early detection of prostate cancer will make them live any longer. I do think people should know the limitations of the evidence."

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