WEDNESDAY, March 14 (HealthDay News) -- Adding another
perspective to one of the most controversial and confounding issues
in medicine, a new European study reports that men who received
routine prostate-specific antigen (PSA) tests to check for signs of
prostate cancer were 30 percent less likely to die from the
But the big picture isn't simple enough for the new research to
solve once and for all the question of whether PSA testing helps
"There is little doubt that a man who undergoes testing will have about a 30 percent less chance of dying from prostate cancer," said the study's lead author, Dr. Fritz Schroder, professor of urology at Erasmus University in Rotterdam, Netherlands. "On the other side, there's a 30 percent chance that a cancer found is insignificant and the patient may be confronted with the side effects of treatment unnecessarily."
Schroder is referring to the major issue in the PSA debate: Do
the PSA tests do more harm than good?
In some cases, the tests detect cancer that would be deadly,
giving men an opportunity to treat it and potentially survive. In
other cases, men are unnecessarily treated for cancer that actually
would develop so slowly that it wouldn't threaten their lives.
There's also the matter of cost -- PSA screenings cost an
estimated $3 billion in the United States each year -- and the
potentially severe side effects of treatment, including
incontinence and impotence. In addition, the new study found that
only about 0.5 percent of men developed the cancer and died from it
in the period reviewed.
For the new study, the scientists examined the medical records
of more than 160,000 men in eight European countries, who ranged in
age from 55 to 69 when the study began. Some were randomly assigned
to receive PSA screening tests.
After an average of 11 years, the men in the study who got
screened were 21 percent less likely to have died from prostate
The study findings appear in the March 15 issue of the
New England Journal of Medicine.
A physician who wrote an accompanying journal commentary said
the new findings "add more confusion" to the issue. But one thing
is clear: They don't convince him that routine PSA tests are a good
The problem is that "you can have prostate cancer sitting there,
doing nothing," said Dr. Anthony Miller, professor emeritus of
epidemiology at the University of Toronto's Dalla Lana School of
Public Health. "It's not going to kill them; it's not going to
But a PSA test can still discover prostate cancer, leading to
unnecessary tests and treatment.
"You'll always find people who are convinced that no matter what is done, the evidence doesn't matter and what they really want to find out is if they have any cancer," Miller said. "They will assume that the mere fact of finding a cancer will mean that good has been done."
Miller recommends the PSA test only for men who have certain
symptoms or if it's used to monitor treatment in men who have
prostate cancer. "As a general screening for healthy men, I do not
recommend it at all," he said.
Miller also doesn't recommend the prostate examination done by
hand that physicians commonly give to middle-aged and older men,
unless symptoms are present.
For more about
prostate cancer, try the U.S. National Library of Medicine.
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