Cancer doctors say broach PSA test with some men

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His group released a decision aid along with its recommendations to help men balance the pros and cons of getting a PSA test (available at http://www.asco.org/pco/psa).

The document, which is based on the European screening study, explains that out of 1,000 screened men, four will die of prostate cancer, compared to five out of 1,000 men who don't get the PSA test.

On the flip side, three-quarters of all the positive tests will turn out to be false alarms. And nine out of 1,000 men who get a biopsy after a positive PSA test will be hospitalized due to fever or infections of the prostate — a number that is on the rise, according to some studies.

Finally, some prostate cancers are slow-growing or don't grow at all, so they would never have been life-threatening. Yet many men choose to get aggressive treatment - surgery, radiation or hormone treatment — which causes incontinence, impotence or both in 20 percent to 40 percent of patients.

Basch said he used to be biased against the PSA test due to those risks, but had been persuaded that some men might still see a benefit.

"Upon review of the evidence my own views changed," he said.

Still, he warned that many tests are made available to U.S. consumers before they have been carefully vetted, including PSA-based screening.

"The test was not adequately evaluated before it came onto the market," Basch told Reuters Health. "Overtreatment is a real problem. In the United States we treat far too many low-grade cancers."

Dr. Otis Brawley, chief medical officer of the American Cancer Society, said ASCO is just one of a number of groups calling for informed decision-making.

"All of those organizations are now saying that men should be informed about what is known and not known about this test and be allowed to make a choice," Brawley told Reuters Health. "Hospitals and organizations doing mass screenings, they all need to realize they need to stop that."

SOURCE: http://bit.ly/aaGhWR Journal of Clinical Oncology, July 16, 2012.