Study: Prostate Screening Saves Lives
PSA Tests Cut Metastatic Prostate Cancer by 35%
"It was astonishing," Coltman says. "We found individuals with prostate cancer at every range of PSA --from 4 down to 0.1. And a substantial number of them had high-grade prostate cancer. In fact, some of these cancers were in men who had gone through seven years of PSA and digital rectal exams and were found to be normal in all respects."
What's a Man to Do?
The American Cancer Society recommends that men over 50 -- or high-risk men over 45 -- discuss with their doctors whether they should begin annual PSA tests and digital rectal exams. Men at high risk include blacks and those with a family history of prostate cancer. Men at especially high risk -- those with multiple first-degree relatives who have prostate cancer -- may wish to begin this conversation even earlier, at age 40.
Even though he's not blind to its faults, Coltman says that men should discuss PSA testing with their doctors.
"I don't think one should dissuade a man from prostate screening, because in fact the screening may show the PSA is elevated and his prostate gland is abnormal," he says. "But doctors must understand that we are going to rewrite the book. Because if PSA is less than 4 or even less than 2.5, you cannot be totally confident there is not a problem."
Coltman suggests that current PSA cutoff levels may be appropriate for men not at high risk. For those in high-risk groups, he suggests that doctors seek biopsies when they detect prostate abnormalities -- even if a patient's PSA is below the current cutoff.
Deciding on prostate cancer screening is a matter of weighing the benefits against the risks. The benefit: catching a deadly prostate cancer while it is still curable; the risk: unnecessary biopsy and, perhaps, surgery or radiation therapy for cancer that would never have been a problem if it hadn't been detected.
Large studies are under way to help men make this difficult decision. But results won't be available for a long time.
"We don't expect results before the end of this decade -- or well into the next decade," Coltman says.