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New Debate on Prostate Cancer Screening

U.S. Study Shows PSA Test Doesn't Save Lives; European Study Shows Modest Benefit

Longer Follow-up May Be Needed

NCI researcher Christine D. Berg, MD, tells WebMD the failure of the U.S. trial to show a survival advantage associated with PSA testing could be due to the relatively short follow-up.

The researchers plan to follow the almost 77,000 men participating in the trial for a total of 17 years, and the men in the PSA arm of the trial will continue to have annual screenings.

Berg points out that in the European study the survival advantage was not seen until after seven years of follow-up.

But she echoed Barry's concerns that costs of PSA screening in terms of increased treatment may not be justified by the benefits.

"Personally, I think we should do some screening, but we really can't say what the optimal screening protocol should be at this time," she says. "The best we can do is counsel men to talk to their physicians."

Current Screening Recommendations

The U.S. Preventive Services Task Force, which makes recommendations about health care screenings, recently concluded that there is insufficient evidence to determine if the benefits of prostate cancer screening outweigh the risks in men younger than 75.

Prostate cancer screening is not recommended for older men.

The American Cancer Society does not support routine prostate cancer screening, but the group does urge men who have an average risk for the cancer, beginning at age 50, to talk with their physician about the pros and cons of screening. These discussions should take place at age 45 for men at higher risk.

"I think you will have a lot more men having this discussion with their health care providers as a result of these studies, and from our point of view that is a good thing," American Cancer Society Deputy Chief Medical Officer Len Lichtenfeld, MD, tells WebMD.

Lichtenfeld says the studies are likely to lead to vigorous debate within the medical community about the value of PSA screening.

"For years we've been saying wait for the trials, but so far the trials have not given us a definitive answer about whether prostate cancer screening is beneficial or harmful," he says.

"I suspect there will be a substantial amount of discussion over the next few weeks and months among the experts to try and put these findings into perspective and try and tease out what the message should be."

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