There certainly are men for whom the PSA test can be a lifesaver. "Screening is definitely called for if a man has a family history of prostate cancer, especially if it spread and couldn't be controlled," says urologist Martin Sanda, M.D., of the Beth Israel Deaconess Medical Center in Boston. Sanda also recommends the test for "African Americans and men with other risk factors for aggressive cancer, including obesity."
Conversation is key
"Previous recommendations of this task force and the American Cancer Society have been that PSA testing should not be done indiscriminately, but doctors should make it available to healthy men and talk about the pros and cons," says Sanda. "That's valid."
Yale University therapeutic radiologist Richard Peschel, M.D., concurs. "Even before agreeing to a blood test, a man should sit down with his doctor and talk about what the doctor will do with the information. Will he recommend a biopsy? What are the available treatment options? For healthy men, it's simply not clear how valuable the PSA test is," he says. "What often happens is that physicians order a PSA and then don't quite know what to do with abnormal results." Peschel follows his own advice. "I'm 65, and I had a conversation with my internist and elected not to go forward with the test."
That decision may become easier, Peschel notes. "One research effort is to discover the genetics behind prostate cancer," he says. "Our hope is that sometime in the not-too-distant future we'll be able to do a simple genetics test to decide whether or not to do a PSA and if it will be useful. Once we have a better hold on the genetic profile of prostate cancer, we'll know who needs testing on a regular basis."
Until then, notes Lee, the decision to have the test, have a biopsy if indicated and get treated or not is ultimately up to the patient. "I don't think it should be taken out of his hands."
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Nissa Simon, who lives in New Haven, Conn., writes about nutrition and medical issues.