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New Debate on PSA Test for Prostate Cancer

Study Suggests Men With Low PSA Levels Can Wait Years Between Screening Tests

Prostate Drug continued...

In a trial involving more than 300 men with early-stage prostate cancer, those who took the drug Avodart had a 40% lower risk of having their cancer get worse, compared to men who took a placebo.

"Among men randomized to placebo, about 23% had no evidence of cancer at final biopsy [three years after entering the study]. But among men on Avodart, it went up to 36%," he tells WebMD.

All the men in the study had opted for active surveillance, also called watchful waiting. It involves regularly monitoring men with early-stage prostate cancer to determine if the cancer is growing and needs treatment.

Vogelzang tells WebMD that many men who opt for active surveillance experience high levels of anxiety, even though research has shown that their prostate cancer is so slow-growing it will probably never kill them.

Studies like this and another showing "PSA drops about 50% with this drug are gratifying to most (prostate cancer) patients. They breathe a sigh of relief," he says.

Even so, Avodart is not likely to be approved by the FDA for this use, Fleshner says.

Robotic Surgery

In another study, researchers who examined the outcomes of nearly 3,800 robotic-assisted laparoscopic radical prostatectomy (RALP) operations performed by three skilled surgeons report that it took more than 1,600 procedures for the surgeons to become proficient.

Introduced in 2000, RALP provides surgeons with three-dimensional vision, improved magnification, hand tremor filtering, and a range of motion similar to the human wrist.

The procedure has caught on quickly: Of the 90,000 surgeries to remove the prostate performed each year in the U.S., about 80% are done robotically.

"This study suggests robotic prostate surgery should be limited to a few centers of excellence, and not every community hospital or every surgeon should be doing the procedures," says researcher Prasanna Sooriakumaran, MD, PhD, a visiting fellow in urology at the Weill Cornell Medical College in New York.

More than 70% of RALPs in the U.S. are performed by surgeons who do fewer than 100 cases a year, he says. 

These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

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