Watch out for bad advice not meant for individual patients!

I have printed below the entire story that was found in several formats throughout the internet in May 2002. The fact that "most" tumors are discovered with some cost saving technique of less screening is exactly what the discriminating individual must ignore! You don't care if the government can save money by doing less. You need to rule out prostate cancer, and catch it early if it shows up. I list this as "news" because it's dangerous advice! Ignore it!


Notice in the text that part of the reasoning that PSA does not need to be tested is that abnormal is defined as PSA above 4.0 ng/mL. We have already told you about two major articles by Dr. William Catalona that demonstrate a cutoff of 2.5 markedly increases sensitivity, and that waiting until the PSA rises to 4 is dangerous and will miss many prostate cancers. This is mentioned as common knowledge in our other article about 1/4 of prostate cancers missed with the initial biopsy.



Some men can skip yearly prostate cancer test
Last Updated: 2002-05-20 16:48:13 -0400 (Reuters Health)

By Jacqueline Stenson

ORLANDO, Florida (Reuters Health) - Though annual blood tests for prostate cancer are often recommended by doctors, many men hoping to detect early signs of the malignancy may not need the test so frequently, new findings suggest.

Men with a very low reading on their initial prostate specific antigen (PSA) blood test can be tested once every 5 years with little chance that their PSA levels will "skyrocket" in the meantime, said study author Dr. E. David Crawford of the University of Colorado Health Sciences Center in Denver.

PSA is a protein that, when elevated, can indicate prostate cancer. A very low PSA level is below 1 nanogram per milliliter of blood. A PSA level of 4 ng/mL or higher is considered elevated, while 3 ng/mL is viewed as normal. In the study, more than 90% of study participants had normal PSA levels at baseline.

The study of nearly 28,000 US men also concluded that a PSA test every 2 years would suffice for men with a baseline PSA of 1 to 1.9 ng/mL, Crawford reported here Monday at a meeting of the American Society of Clinical Oncology (ASCO).

The American Cancer Society and the American Urological Association support annual PSA testing and digital rectal exams beginning at age 50 for most men. However, many medical groups, including the National Cancer Institute, leave the decision up to patients and their doctors because no study to date had confirmed that screening actually saves lives. ASCO has no position on prostate cancer screening, according to a spokesperson.

Experts point out that screening may actually cause harm by leading to unnecessary testing, treatment and anxiety. An elevated PSA test can indicate cancer but it can also signal other benign conditions, such as an enlarged prostate, and therefore may lead to unnecessary biopsies and other tests. And because most prostate cancers are slow growing, many men will die of other causes before the cancer ever becomes life-threatening. Surgery to treat the cancer can cause impotence and incontinence.

In light of the controversy, Crawford said the new study should be used to guide doctors and patients as they discuss whether to test.
He estimated that if US men followed the guidelines of the study, there would be a 55% decrease in the number of annual screenings at a cost savings of $500 million to $1 billion.
And 99% of men would have a normal PSA result on the years that they skipped testing, Crawford reported.

As for men with baseline PSA levels of 2 to 3.9, they should probably be more closely watched, with annual screenings, because they are more likely to experience elevations in their PSA levels that put them in more of a potential danger zone, he said.

The findings were drawn from a sample of 27,863 men aged 55 to 74 participating in a large ongoing study by the National Cancer Institute. One of the goals of this study is to determine whether prostate cancer screening, both PSA testing and digital rectal exams, are beneficial.

Dr. Steven Woolf, a professor of family practice and preventive medicine at Virginia Commonwealth University in Fairfax, said the new study findings emphasize the need for doctors to spend more time discussing the pros and cons of PSA testing with their patients so that men can make a more informed decision.

Prostate cancer is the second-leading cancer killer of American men. An estimated 189,000 US men will be diagnosed with prostate cancer this year and 30,200 will die from the disease, according to the American Cancer Society.

Copyright © 2002 Reuters Limited. All rights reserved.