Panel: Healthy men shouldn't get prostate test

Healthy men should no longer receive a PSA blood test to screen for prostate cancer because the test does not save lives overall and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided. The draft recommendation, by the U.S. Preventive Services Task Force and due for official release next week, is based on the results of five well-controlled clinical trials and could substantially change the care given to men 50 and older. There are 44 million such men in the United States, and 33 million of them have already had a PSA test sometimes without their knowledge during routine physicals. The task force's recommendations are followed by most medical groups. Two years ago the task force recommended that women in their 40s should no longer get routine mammograms, setting off a firestorm of controversy. The recommendation to avoid the PSA test is even more forceful and applies to healthy men of all ages. "Unfortunately, the evidence right away shows that this test does not save men's lives," pronounced Dr. Virginia Moyer, a professor of pediatrics at Baylor College of Medicine and chairwoman of the task force. "This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does." But advocates for those with prostate cancer promised to fight the recommendation. Baseball's Joe Torre, financier Michael Milken and former New York Mayor Rudy Giuliani are among tens of thousands of men who believe a PSA test saved their lives. The task force can also expect resistance from some drugmakers and doctors. Treating men with high PSA levels has become a lucrative business. Some in Congress have criticized previous decisions by the task force as akin to rationing, although the task force does not consider cost in its recommendations. "We're disappointed," pronounced Thomas Kirk of Us TOO, the nation's largest advocacy group for prostate cancer surv! ivors. " The bottom line is that this is the best test we have, and the answer can't be, 'Don't get tested.' " But that is exactly what the task force is recommending. There is no evidence that a digital rectal exam or ultrasound is effective, either. "There are no reliable signs or symptoms of prostate cancer," pronounced Dr. Timothy J. Wilt, a member of the task force and a professor of medicine at the University of Minnesota. Frequency and urgency of urinating are poor indicators of disease, since the cause is often benign. No ill effects for most The PSA test, routinely given to men 50 and older, measures a protein prostate-specific antigen that is released by prostate cells, and there is little doubt that it helps identify the presence of carcenogenic cells in the prostate. But a vast majority of men with such cells never suffer ill effects because their cancer is usually slow-growing. Even for men who do have fast-growing cancer, the PSA test may not save them since there is no proven benefit to earlier treatment of such invasive disease. As the PSA test has grown in popularity, the devastating consequences of the biopsies and treatments that often flow from the test have become increasingly apparent. From 1986 through 2005, 1 million men received surgery, radiation therapy or both who would not have been treated without a PSA test, according to the task force. Among them, at least 5,000 died soon after surgery and 10,000 to 70,000 suffered serious complications. Half had persistent blood in their semen, and 200,000 to 300,000 suffered impotence, incontinence or both. As a result of these complications, the man who developed the test, Dr. Richard J. Ablin, has called its widespread use a "public health disaster." One in six men in the U.S. will eventually be found to have prostate cancer, making it the second most common form of cancer in men after skin cancer. An estimated 217,730 men received the diagnosis last year, and 32,050 died. The disease is rare before age 50, and most deaths occur after age 75.! Not kno wing what is going on with one's prostate may be the best course, since few men live happily with the knowledge that one of their organs is cancerous. Autopsy studies show that a third of men ages 40-60 have prostate cancer, a share that grows to three-fourths after age 85. Men over age 70 PSA testing is most common in men over 70, and it is in that group that it is the most dangerous since such men usually have carcenogenic prostate cells but benefit the least from surgery and radiation. Some doctors treat patients who have high PSA levels with drugs that block male hormones, although there is no convincing evidence that these drugs are helpful in localized prostate cancer. The task force's recommendation applies only to healthy men without symptoms. The group did not consider whether the test is appropriate in men who already have suspicious symptoms or those who have already been treated for the disease. The recommendations will be open to public comment next week before they are finalized.

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