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Prostate cancer over diagnosedThe study also reports in the Aug. 31 online issue of the Journal of the National Cancer Institute that since the PSA screening test came into use in 1986, federal government data show that the number of prostate cancer cases in the United States has risen substantially. Prostate cancer treatments include surgery and radiation therapy, and possible side effects are incontinence and impotency. Dr. H. Gilbert Welch, one of study co-author, thinks that "The ideal screening test would have no effect on the number of cases. It would change the time in life that the cancers were diagnosed, but not the number. Instead, there has been a sustained change in the number of cases - 1.3 million more that would not have been diagnosed previously." The death rate from prostate cancer has fallen in the United States, but not necessarily because of mass screening, Welch contended. "There are a number of reasons why mortality might fall, but the most obvious is that we have better treatment, " he said. "Even without early detection, I expect mortality would fall." Results of a European study reported earlier this year indicated that "to save the life of one man, 50 must be over-diagnosed," he said. Guidelines for screening for blood levels of PSA -- a protein produced by the prostate gland -- differ widely. The American Cancer Society says that a PSA test should be offered at age 50, accompanied by an explanation of the potential benefits and hazards. The American Urological Association recommends a first PSA test at age 40, with follow-ups depending not only on the test score but also on factors such as ethnicity. But Dr. Judd Moul, director of the Duke University Prostate Center, after reading the new study, said, "This is not going to change my mind on the issue of screening." Moul thinks it is more important to try to reduce the number of deaths than to worry about over-detection. Both Moul and Welch agree that the PSA test is decidedly imperfect because it can't distinguish between the majority of prostate cancers that grow so slowly that they are no danger to a man's life and the fast-growing minority that are potentially fatal and require decisive treatment. NOTE: Issues on this site regarding prostate cancer and treatment options, are provided for information only, and are not meant to substitute for the advice of your own physician or other medical professional. Prostate-Report.org does not endorse any specific product, service or treatment. |
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