A recent statement from the U.S. Preventive Services Task Force, an independent panel commissioned by the national government, touched off fresh controversy about screening for prostate cancer with the PSA (prostate specific antigen) blood test.

Saying research doesn't show clearly that PSA screening helps save lives, the group recommended that routine tests are not necessary for healthy men. MD Anderson guidelines call for annual PSA tests after 50, or after 45 for African-American men and men with a close relative with prostate cancer.

Doctors, survivors disagree with findings

But many men whose lives have been saved by finding prostate cancer early disagree with the panel's recommendations. Physicians, too, are lining up to defend PSA screening, citing statistics that show fatalities have dropped 40 percent since the tests came into use almost 20 years ago.  

Dr. Andrew K. Lee, medical director for the Proton Therapy Center and associate professor of Radiation Oncology at MD Anderson, believes the task force's conclusion is premature. He encourages men to be screened, especially if they're at a high risk.  

"It's a personal decision, of course," he says. "But it's a good idea to talk to your doctor and educate yourself about the pros and cons of the test - and prostate cancer in general."

Further discussion is certain

Advocates of testing say the studies examined were flawed and should not be used to make recommendations that could impact the lives of so many.

 "Remember, the PSA is just a blood test," Lee says. "It does not make the diagnosis by itself, but it is a valuable tool for early detection."

Stay tuned. The period for public comment ends soon, and there's sure to be more discussion in the media.

- MD Anderson Proton Center Staff October 2011 

Prostate-cancer survivor Rudy Giuliani yesterday blasted a government-backed panel's advice to abandon routine  

prostate screening, joining a chorus of MDs decrying the recommendation as shoddy and dangerous.   

"The [prostate-specific antigen] test saved my life," Giuliani told The Post, noting he was in "perfect health" when he was tested at age 56. "I believe it's the reason I'm alive. It's really a mistake to move away from this. It's very dangerous[ to abandon the test].''

• In the American study, substantial numbers of both the control arm (i.e., the non-PSA screened) group and the intervention arm (the PSA screened group) underwent PSA screening. If you're comparing PSA screening with no PSA screening, all of the men in one of the 2 groups are screened and none of the men in the other group are screened, right? Well, that's not what happened in the American study. Instead, the American study compared one group of men where 52% had PSA screening while 85% of the other group had PSA screening. When you have 52% of the non-PSA group taking the test, you have what is called "contamination" of the control group. By contrast, the Swedish study had only 3% contamination and the European study had only 20% contamination. No wonder the results of the PSA test in the American study were so poor, compared to the Swedish study and the European study.

• Follow up biopsy rates on patients with positive PSA readings were low in the American study (40%), compared to the 90% biopsy rate in the European study and 93% in the Swedish study. Unless you follow up a positive PSA test with a biopsy, you can't begin to tell whether the PSA test actually reveals prostate cancer or not. Yet the American study follow ups were half-hearted at best, compared to the European and Swedish studies.

• The follow up times in the American study were way too short, compared especially to the Swedish study. The follow up time in the American study in which the death rates were measured from the date of the PSA test was only 7-10 years in the American study, compared to 14 years in the Swedish study (and only 9 years in the European study). Medical studies demonstrate that you can use the PSA test and a biopsy to find out whether you have cancer or not many years before the cancer actually shows up from a DRE or other symptoms. In this way, the PSA test enables early detection of prostate cancer by many years, compared to not taking it. In one well-known study, the PSA test advanced prostate cancer diagnoses by as much as 12 to 14 years among men aged 55, and by 5 to 6 years for men aged 75. Seven to ten years in the American study is not nearly long enough to compare death rates with PSA and death rates without the test. Because the Swedish study measured the death rates 14 years after the PSA tests were taken, by then there were many more men without the test showing up with prostate cancer. The Swedish study was a fair test of PSA screening, while the American study was not.

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