Prostate test not as effective as once thought

March 28, 9:27 PMColumbia Health Care ExaminerJan Louthain

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Once thought to be the best diagnostic tool for early detection of prostate cancer, PSA tests have been used routinely by most physicians since they were approved by the FDA in 1987. Now studies show they may not be that effective and may even result in men having unnecessary surgery or radiation.

PSA stands for prostate-specific antigen which is a protein found in the prostate cells and can be determined by testing a man's blood. Current guidelines recommend that all men have an annual PSA test starting at age 50. If the PSA level exceeds 4 nanograms per milliliter of blood or if there has been a significant rise between two tests, this could suggest the presence of cancer and a biopsy is recommended.

The two recent studies (one in Europe and one in America) while showing different results both indicate that PSA tests may not be worth the risks involved. The American study of 77,000 men conducted by the American Cancer Institute showed that those who received annual PSA blood tests did not have a reduced rate of death from prostate cancer. The European test of 187,000 men found that for every man whose death was averted because of the PSA test, another 48 men ran the risk of having unnecessary treatment. Surgery for prostate cancer can sometimes result in impotence and incontinence; and when the treatment is radiation, the side effect can be painful defecation or chronic diarrhea.

Dr. David F. Ransohoff, an internist and cancer epidemiologist at the University of North Carolina finds the studies important. “This is not relying on modeling anymore,” he said. “This is not some abstract, pointy-headed exercise. This is the real world, and this is real data.”

According to Dr. Eric Horwitz, a radiation oncologist and prostate-cancer specialist at Fox Chase Cancer Center in Northeast Philadelphia, “PSA is a great test if it's used the right way.” He believes the PSA level has to be interpreted in relationship to the man's age and his previous tested levels. A sudden rise in the PSA level can be more indicative of a problem than a level that stays the same.