Prostate Cancer Screening's Toll
One of the most controversial issues in men's health is whether a blood test commonly used to screen for prostate cancer is being overused.
Well, there's new evidence out this week that the test has led to a lot of men getting unnecessary treatment.
The test, known as the prostate-specific antigen (PSA) test, measures a protein in the blood produced by the prostate gland. Doctors started using it routinely around 1987 to spot men with prostate cancer early. Prostate cancer is diagnosed in more than 218,000 men in the United States each year. and kills about 28,000, making it the second leading cancer killer in men after lung cancer.
But because prostate cancer grows so slowly, it never causes problems for a lot of men who have it. Many end up dying of something else without ever knowing that they had it. Because of that, there's been an intense debate over whether routine PSA testing is excessive.
In the new study, H. Gilbert Welch of the VA Outcomes Group in White River Junction, Vt., analyzed federal cancer statistics between 1986 and 2005 and calculated that 1.3 million men had been diagnosed with prostate cancer since PSA testing began.
Of those, more than 1 million underwent treatment, most of whom probably did not need any treatment, according to a report in the Journal of the National Cancer Institute.
For every one man whose life was saved by PSA testing, at least 20 underwent unnecessary treatment that may have left them incontinent, impotent and suffering from other side effects, the researchers calculated.
"It's really important that men come into these screening decisions with full knowledge of the benefits and harms," Welch said during a telephone interview.
Welch also noted that PSA testing has meant that men tend to get diagnosed much younger than they used to. Diagnosis more than tripled since 1986 among men ages 50 to 59 and increased more than sevenfold among men under age 50.
In an editorial accompanying the study, Otis Brawley, the American Cancer Society's chief medical officer, said the findings underscore the need to find ways to identify the men with prostate cancer who really need treatment.
Brawley noted that the study comes at a time when the health care reform debate has focused attention on health care costs. One way to control spending, Brawley noted, is to reduce unnecessary treatment.
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