Analyze this – prostate cancer research

“Study: Routine prostate cancer testing does not save lives

By Brian Vastag, Published: January 6

Find prostate cancer early, save a life.

That message has been pervasive since 1986, when a blood test for prostate cancer first hit the market. But more evidence suggests that, in many or even most cases, the message is wrong.

The latest blow against prostate-specific antigen (PSA) testing came Friday from a large, long-term study that found routine testing in men ages 55 to 74 did not prevent deaths from prostate cancer.

“The message is that routine mass screening is not the way to go,” said one of the leaders of the study, Gerald L. Andriole Jr. of Barnes-Jewish Hospital in St. Louis. “But we don’t need to throw out PSA testingaltogether.”

Andriole said the large majority of prostate cancers found by PSA testing were slow growing and nonlethal. But no test can sort out the potentially deadly cancers from the nonfatal kind, forcing many men to undergo unnecessary surgery, radiation and drug therapy. Those treatments often leave men incontinent and unable to function sexually.

The new study, however, is unlikely to settle the long-running debate over the value of PSA testing, as prominent advocates of the tests said the results did not change their views.

“It’s a flawed study,” said William J. Catalona, a prostate cancer surgeon at Northwestern University in Chicago who helped develop the PSA test. “It doesn’t really address the question of whether PSA screening saves lives.”

Launched in 1993, the National Cancer Institute-funded study followed 76,000 men at 10 sites nationwide for about 13 years. Half received annual PSA tests for six years and also received digital rectal exams, which can help detect some prostate tumors. The other half, in the “community care” group, continued under the care of their regular doctors. Although doctors found about 12 percent more cancers in the PSA screening group, both groups had about equal numbers of deaths. Detecting the extra cancers, in other words, did not reduce the death rate from the disease.

“There is a tendency to believe that if a test finds disease, that must be a good thing,” saidOtis Webb Brawley, a cancer screening expert and chief medical officer of the American Cancer Society. But that isn’t necessarily so, he said, adding, “I’m very worried about ‘auditorium medicine,’ where a long line of guys waits to get screened and there is no discussion or education about the potential risks and benefits.”

Ideally, none of the men in the “community care” group would have received PSA testing. That would have made the study a clearer test of whether the screening saves lives. But in the 1990s, primary care physicians rapidly adopted routine screening in men 50 and older. About half of the men in the “community care” group did, in fact, receive PSA testing.

That factor muddied the results, said Jonathan W. Simons, an oncologist and chief executive of the Prostate Cancer Foundation, a patient advocacy group. “The study is so fundamentally flawed it doesn’t move us forward in what we need to do to reduce deaths from prostate cancer.””