Necessity of prostate cancer screenings debated

(NBC) - A government advisory panel says most men should not get one the most common tests available to detect prostate cancer. The recommendation could drastically revamp the way men over 50 are treated.

After a routine blood test showed William DePaula had prostate cancer, he and his doctor opted to remove the cancerous tissue with surgery.

"I wanted them out of my system, so I favored the surgery," said DePaula.

The aggressive treatment may have been a lifesaver for DePaula because he has a family history of the cancer. But for most healthy men a government advisory panel now says a routine PSA blood test is unnecessary.

"There have been several studies looking at prostate cancer screening," said Dr. Otis Brawley of the American Cancer Society. "The majority of those studies have failed to show that prostate cancer screening saves lives."

PSA stands for prostate-specific antigen. It's a protein released by the prostate when cancerous cells are present. Most men are never affected by these cells and the PSA test does not show how aggressive the cancer is.

Going forth with treatments like surgery can leave men incontinent and impotent. Some experts warn certain medications used to treat prostate cancer increase the risk for heart disease, killing patients long before they'd ever die from the cancer.

"A man actually trades cause of death: cardiac disease earlier instead of prostate cancer death later," Dr. Brawley said.

Dr. Brawley suggests that could be why the death rate due to prostate cancer has declined over the past 20 years. Other renowned specialists disagree, standing by the PSA test.

"Men with the most aggressive cancers actually have a pretty good survival at 15 years," said Dr. Eric Klein of the Cleveland Clinic. "That's the benefit to screening is finding those high grade, potentially lethal cancers."

The U.S. Preventive Services task force will make the new PSA recommendations, which aren't yet final. But the group does not get the final say. Men will still be able to get the tests if they choose to.

The Preventive Services task force does not consider cost, but its opinion can prompt major medical organizations to re-evaluate their own policies and influence health insurance companies on reimbursement. Medicare, however, is required to pay for PSA tests regardless of the task force's recommendations.

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