Screening for prostate cancer still a gray area: study findings raise questions about whether or not the PSA test saves lives.(CANCER)

Prostate cancer is the second-leading cause of cancer death in American men, killing more than 28,000 each year. While it's usually treatable if it's discovered soon enough, detecting the condition remains an inexact science. Two recent studies that evaluated the impact of prostate screening on mortality provide mixed messages in regard to its success.

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Gerald Andriole, MD, chief urologic surgeon at Washington University's Siteman Cancer Center and lead author of one of the studies, says it's too soon to make broad screening recommendations for all men based on the initial findings. But, he continues, "the important message is that for men with a life expectancy of seven to 10 years or less, it is probably not necessary to be screened for prostate cancer."

NON-SPECIFICITY A PROBLEM. The standard screening tool for prostate cancer measures levels of a protein called prostate-specific antigen (PSA) in the blood. PSA tends to be elevated by prostate cancer (as well as benign prostate conditions) but while a high reading may flag the presence of a life-threatening tumor, it also can indicate slower-moving cancers that would never become serious enough to cause death.

Because the test isn't specific, a high reading must be followed by a biopsy to see if cancer is present. If it is, many men undergo potentially aggressive treatments that can impair their quality of life, potentially causing incontinence and impotence, even though it often is likely the cancer will progress so slowly it won't be fatal. Hence the standard statement among doctors that more men die with prostate cancer than of it.

The uncertainty surrounding the PSA test is underscored by the two studies, both published March 26 in the New England Journal of Medicine. Dr. Andriole's, which followed 76,693 men, age 55 to 74, for seven years, found no reduction in prostate cancer deaths among those participants who had regular PSA tests--in fact there were more deaths from prostate cancer among those tested than among the unscreened control group. "It's ...