Akron Beacon Journal...
To test, or not to test?
Editorial  
October 14, 2011 

As health-care consumers, most of us heed the counsel of medical professionals, who long have advised regular screenings to catch prostate or breast cancers in the early stages, when treatment is effective and the odds of recovery are better. What, then, when a federal task force, based on an independent review of large clinical trials, advises against routine testing for prostate cancer? 

Among other conclusions, the review found no benefit to the blood test for prostate-specific antigen, PSA. For the majority of men who are diagnosed, the disease grows so slowly that they are more likely to die of other causes. In many instances, treatment is unnecessary and may expose patients to greater risks than the disease, such as complications from infections. In about 20 percent to 30 percent of cases, surgical or radiation treatment leads to incontinence, impotence or both. 

As can be expected, the recommendation to reverse a practice that is heavily promoted — and has become an annual ritual for many men — is generating some confusion and controversy. There is no shortage of patients convinced that they owe their survival to screening and early detection. Besides, the recommendation leaves men in the difficult position of concluding it is better not to know if they have prostate cancer or that they are better off ignoring it if they do get a diagnosis. 

The recommendation also touches on the question of vested interests and the effectiveness of medical practices, not to mention the costs of unnecessary screenings and treatments. Many urologists have criticized the basis for the PSA recommendation, pointing out that deaths from prostate cancer have dropped significantly in the United States with increased PSA screenings. 

In the end, the recommendation points to a more nuanced approach: For men at high risk, say, black men and men with a family history of the disease, the option is to continue with regular screenings. 

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