Study: Prostate cancer test doesn't cut death risk

[Batman (imported)]

http://yourlife.usatoday.com/health/med ... eedfetcher

The longest study yet on prostate cancer testing provides more evidence that getting screened doesn't cut the chances of dying from the disease.

In a 20-year study of more than 9,000 Swedish men, researchers found no difference in the rate of prostate cancer deaths between the men who were periodically screened and those who weren't.

Routine screening for prostate cancer is controversial and the new results aren't likely to end the debate about the value of testing. Critics say screening leads to unnecessary biopsies and treatment with little proof that it saves lives. Testing is done with a physical exam and a PSA blood test.

"There is no escaping the fact that we need a better tool ... to help detect prostate cancers that actually need treating, as opposed to innocent ones that do not," said Malcolm Mason, a prostate cancer expert at Cancer Research U.K. in a statement. "In the meantime, men should be fully informed about the pros and cons of having their PSA measured."

The standard PSA blood test looks for high levels of prostate specific antigen. The test is controversial because the PSA level can be high for many reasons. A positive result must be confirmed by a biopsy.

If prostate cancer is found, there's no agreement on the best way to treat it: "watchful waiting," surgery, hormone therapy, radiation, or some combination of those. Most tumors grow so slowly they are never life-threatening, and the treatments can have serious side effects.

The Swedish study was done in the eastern Sweden city of Norrkoping. From 9,026 men, about 1,500 were randomly selected to be screened every three years from 1987 to 1996. They only got digital exams on the first two visits; the PSA test was added for the next two. For the fourth and final screening, only men aged 69 or under were included. The remaining 7,532 men were not screened.

During the 20 years of follow-up, 85 men (about 6%) in the screened group and 292 men (about 4%) in the no-screening group were diagnosed with prostate cancer. The death rate from prostate cancer was similar in both groups, the researchers reported.

The tumors found in the men who got tested were smaller and mostly hadn't spread compared to the tumors found in the other group.

"Screening for prostate cancer did not seem to have a significant effect on mortality," wrote Gabriel Sandblom of the Karolinska Institute in Sweden and colleagues.

The study was paid for by the Swedish Cancer Foundation and other groups. It was published online Thursday in the journal, BMJ.

The American Cancer Society does not recommend routine screening for most men and there is no government screening program in Britain because officials say the PSA test is too unreliable. Two other big papers published in recent years have also failed to show much benefit for screening. That includes a large European study that found screening for prostate cancer could pick up cases a decade earlier, but to prevent one death from cancer, 1,410 men would have to be tested and 48 men treated.

False positive tests can cause significant harms, including psychological distress and treatments that can cause impotence and incontinence.

[moi621 (imported)]

Yup!

You either got the fast consuming one like Frank Zappa or more likely the slow slug that barely qualifies as a "malignancy" and prognosis has more to do with the behavior of the malignancy then the treatment or lack of treatment.

The problem is there is no way to diagnose these tumors on a predicted behavior basis as they "all look alike".

If the active, aggressive form could be reliably diagnosed from the virtually inactive form - real treatment advances might occur.

Autopsies often revealed incidental tumor finding that were not causative in death. It was always the prostate.

This is stuff I have said before and was soundly cyber thrashed for not advocating prudent prostate screening. Always nice to see another study agree with me.

Moi

[Woggler58 (imported)]

"

This is stuff I have said before and was soundly cyber thrashed for not advocating prudent prostate screening. Always nice to see another study agree with me.

"

No intent to re-thrash here, but what the original poster relied on and linked to is a mass-media journalist's interpretation of who-knows-how-many earlier media layperson interpretations. No original medical journal article text in its original context was supplied. What about tracking rate of rise in PSA (PSA velocity) as an indication of how lively a prostate cancer might be, if present at all? What about the lab test that compares free PSA to total PSA, which is a pre-biopsy indication of whether elevated PSA is likely to be cancer-caused? Also there is steady progress in resolution accuracy and reduction in cost of non-invasive prostate imaging, that in time may become routine.

My own encounter with prostate cancer and my postings on the value of PSA testing are available via my EA Profile, hence no further arguments from me now.

Anyone is welcome to read abstracts on prostate cancer via daily (Tues-Sat) emails sent by urotoday(dot)com of Berkeley CA as their "UroAlerts." I do. Differences of opinion exist there too, FWIW.