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)

Catalona, a prostate cancer screening pioneer, also asserts that the task force didn't properly interpret the research it cited. The panel combined data from studies of varying quality, thus diluting results from the more rigorous studies that showed a more positive outcome from PSA testing, he said.

Eggener said he's the first to admit that PSA testing is imperfect. Some men with high PSA levels are cancer-free; other patients with lower levels get aggressive cancers. But those scenarios are the minority, he said.

PSA screening is "the best test we have," Eggener said. "Generally speaking, every study that's been done (on a population) shows that your PSA is correlated with risk of having cancer, risk of being diagnosed with an aggressive cancer and your risk of dying from cancer."

Eggener agreed that men whose life expectancy is less than a decade are less likely to benefit from PSA tests and more likely to be harmed by prostate cancer treatment. But he believes that healthy men who are likely to live at least 10 more years should undergo PSA testing.

Catalona recommends annual PSA testing for men starting in the 40s, up to age 75.

Despite the task force recommendation, Dr. Joseph Goldstein, a family practitioner in Des Plaines and Palatine, said he has continued to recommend the PSA test for men older than 50 because finding problems earlier gives patients more options. So far, none has decided against it.

"I think we've been saving a lot of lives with it," he said. "By not doing the test at all, we might be denying somebody something."

But besides the screening, it's the ensuing "considerable over-treatment" of prostate tumors that also concerns the task force. Many men diagnosed with prostate cancer endure serious side effects from treatment — incontinence and erectile dysfunction are the big two — when their cancers are too slow-growing to cause harm in their lifetimes, the panel said.

Nearly 90 percent of men with PSA-detected prostate cancer receive treatment, which can include surgery or radiation, and at least 20 to 30 percent of men who undergo such treatment experience "adverse effects," the task force said.

Eggener said the task force recommendation does raise many concerns that doctors should discuss with prostate cancer patients before they undergo treatment. Besides just a PSA number, doctors can consider other factors, like the feel of the prostate and biopsy results, to determine if a cancer is aggressive enough to warrant treatment.

If a cancer is determined to be a low-risk form, patients can opt for active surveillance, which usually involves checkups and PSA tests every six months and biopsies every one to two years.

"Low-risk prostate cancer has an incredibly low risk of ever causing problems in the future," Eggener said. "If at any point it seems to grow, it's still very curable."

Chicagoan Robert Martin, 74, chose the active surveillance route when he was diagnosed with prostate cancer last year. Knowing his father also developed prostate cancer and lived almost to 100, Martin said he would rather not risk the potential side effects of treatment.

"It's such a nebulous thing, this prostate cancer. There are different ways of attacking it," he said. "I don't want to rush into something."

Catalona said he wouldn't recommend active surveillance for men with a long life expectancy. Men often miss the opportunity to be cured, he said, because either the cancer spreads or a sampling error made it appear low-risk when it really was aggressive.

Aggressive prostate cancers are misdiagnosed as low-risk 30 percent of the time, he said. And Catalona stresses that treatment doesn't mean patients will end up incontinent or impotent. Having performed about 5,600 nerve-sparing radical prostatectomies, Catalona said, he has thousands of patients who have no such side effects.

Terry Cray, 54, and his twin brother, Tom, both had their prostates removed on the same day in 2003. Within weeks, any issues he had with incontinence were gone, Terry Cray said. After three months, erectile function was normal.

The worst part of the entire experience was getting the call that he had cancer, Cray said.

"Basically for cancer, it was a walk in the park," said Cray, of Vernon Hills. "We were pretty lucky."