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Getting Tested for Prostate Cancer May Be Worth It After All

From TIME - September 5, 2017

Men trying to follow the advice on whether they should get screened for prostate cancer have long been confused, since guidelines and recommendations keep changing. Now, in the latest analysis of data published in the Annals of Internal Medicine, researchers conclude that testing does help save lives from the disease and is linked to as much as a 32% decrease in prostate cancer deaths, compared to men who arent screened.

But that does not mean the debate is over.

For decades since the 1980s, doctors have recommended that men start to get an annual blood test that can detect possible signs of growing tumors: one for the prostate specific antigen (PSA). But PSA testing has always been tricky, since prostate cancers (unlike breast cancer tumors) tend to grow more slowlyso slowly, in fact, that most men are more likely to die of something else other than prostate cancer. That made treating prostate cancer detected by the blood test less black and white. It also led many men to get biopsiesa relatively safe procedure, but one that still carries potential complications like infectionsand even treatment with surgery, radiation or other therapies to remove the tumors, despite the fact that they were slow-growing.

In the U.S., that led to a surge in what some doctors view as unnecessary medical treatments that put men at risk without providing them much benefit. (For most men, prostate cancer isnt fatal.) So in 2012, the U.S. Preventive Services Task Force (USPSTF) issued a recommendation that most men ages 55 to 69except for those who have a family history of the disease or are at high risk of developing the cancershould not get PSA testing at all.

The task force based its conclusion on two large studies, one conducted in the U.S. and the other in Europe, which were published simultaneously in the New England Journal of Medicinebut had apparently opposite results. The U.S. study, the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial (PLCO), did not find any difference in deaths from prostate cancer among men 55 to 74 years who were screened with PSA and men who were not screened. The European Randomized Study of Screening for Prostate Cancer (ERSPC) which included men 55 to 69 years, however, found that PSA screening led to a 21% lower risk of dying from prostate cancer during the study follow-up compared to men who didnt get screened. Given the uncertainty, and the risks of treating cancers that were not aggressive, the USPSTF decided there wasnt convincing enough evidence to recommend PSA screening.

MORE: Fewer Men Are Getting Prostate Cancer Blood Tests, And That May Not Be a Good Thing

But in a new look at the same data from the two studies, published in the Annals of Internal Medicine, researchers, including some involved in both of the earlier trials, conclude that PSA does indeed help reduce death from the disease. The scientists report that the two studies used different methodologies and definitions, so comparing their results was like comparing apples and oranges. In the U.S. study, for example, many of the men in the so-called non-screened group had actually had PSA testing at least once, since the testing is so widespread in America. That meant they might have already had treatments related to their results as well. The PLCO study also screened men every year, while the ERSPC screened men every two to four years.

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