Doctors defend prostate screening

A doctor loads DNA samples onto a gel while searching for variations in genetic samples that would point to someone's susceptibility to lung, prostate, breast and colo rectal cancer at the UCSF Comprehensive Cancer Center August 18, 2005 in San Francisco, California.(Justin Sullivan/Getty Images)

For most of the last decade, Ronald Vari watched helplessly as his PSA level steadily rose, all too aware that the pattern could be a sign of prostate cancer. Yet initial biopsies didn't detect the disease.

Confused and frustrated, the Chicago resident began to question the worth of the PSA, a routine blood test that recently has come under fire from a federal health care panel.

"I was on their side before (doctors) found the cancer," said Vari, 60, whose PSA tests ultimately led to his diagnosis. He now believes the screening saved his life.

"You have to keep doing it," he said. "If you gave up, who knows what the results would be?"

Some local experts and doctors also believe the government-appointed U.S. Preventive Services Task Force was wrong to suggest that men without symptoms forgo the PSA test.

The task force found that early detection of prostate cancer often leads to unneeded surgeries and radiation treatment, which can cause life-altering side effects even though they don't always extend the life of the patient.

Some task force critics agree that the PSA, or prostate-specific antigen, test is imperfect but believe it's the best option available to detect one of the most common forms of cancer, which claims about 32,000 people each year in the U.S.

And experts say many of the task force's concerns about treatment can be minimized by experienced physicians using up-to-date guidelines and techniques.

"In general, I think it's a bad idea to encourage all young, healthy men to stop" getting tested, said Dr. Scott Eggener, urologic oncologist at the University of Chicago Medical Center. "PSA screening definitely saves lives."

In its draft recommendation released in October, however, the task force asserts that the harms of PSA screening outweigh its benefits.

Though the test detects many cases of asymptomatic prostate cancer, the majority of men whose cancer is found through a PSA have slow-growing tumors that will not affect their life spans or health, the task force said.

The panel pointed to evidence indicating that 95 percent of men with prostate cancer detected through a PSA test did not die of the cancer within 12 years, even those who didn't get "definitive treatment."

"The evidence is convincing that for men aged 70 years and older, screening has no mortality benefit," the task force's draft statement said. "For men aged 50 to 69 years, the evidence is convincing that the reduction in prostate cancer mortality 10 years after screening is small to none." Prostate cancer is rare before age 50.

But local experts point to other data that they say show that PSA screening, which began in the early 1990s, reduces prostate cancer deaths.

From 1992 to 2005, the age-adjusted prostate cancer death rate in the U.S. dropped almost 40 percent, according to the federal Centers for Disease Control and Prevention.

Before the PSA test, many men weren't diagnosed with prostate cancer until it had already spread, "and they died from it," said Dr. William Catalona, Northwestern University urology professor and director of the prostate cancer program at the Robert H. Lurie Comprehensive Cancer Center. "And it's a really terrible death."

Eggener said improvements in treatment cannot alone account for the drop-off in the death rate.

Vari, whose prostate was removed last year, said that for years the only indicator of his cancer was an elevated PSA. Without the test, Vari said, doctors wouldn't have discovered his aggressive tumor in time.

"The biggest concern I had was ... not knowing if there was cancer — years of anguish and not knowing," he said. "Finding it was the biggest relief that there is. ... I was very fortunate."