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Panel: Don't Get PSA Prostate Cancer Screen

Harm Outweighs Benefit of Routine Prostate Cancer Screening, Task Force Says
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PSA Test: Controversial Issues continued...

The biggest disagreement, however, is over how to weigh the lives saved by PSA screening against the risks of giving harmful treatments to men whose prostate cancers would never have killed them.

"The side effects of treatment occur often, occur early, and persist for the rest of a man's life," LeFevre says. "There are harms associated with overdiagnosis and overtreatment. The amount of time one spends living with one of those complications is much greater in the screened group."

D'Amico sees it differently.

"It comes down to the relative merit in a man's mind of having urinary incontinence which you can fix with a sphincter, or impotence for which you can get an implant; or having prostate cancer spread to the bone, riddling you with pain and taking your life," he says.

PSA Test: What Men Should Do

While the USPSTF recommends against routine PSA testing, it doesn't say that men should never opt for it.

The American Cancer Society likely will keep its recommendation that a man not get a PSA test until he has discussed the harms as well as the benefits with his doctor.

Many members of the American Urological Association feel strongly that men should seek the test. But the official AUA recommendation is very close to that of the American Cancer Society: They say men should discuss the benefits as well as the harms with their doctors.

The USPSTF recommendation raises the question of why so many U.S. men get PSA tests -- and why they are likely to continue doing so despite the new advice. Otis Brawley, MD, chief science officer at the American Cancer Society, suggests an answer in an editorial accompanying the USPSTF recommendation.

"Americans have been taught for decades to fear all cancer and that the best way to deal with cancer is to find it early and treat it aggressively," Brawley writes. "As a result, many have a blind faith in early detection of cancer and subsequent aggressive medical intervention whenever cancer is found. There is little appreciation of the harms that screening and medical interventions can cause."

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