· An Aug. 1 Page One article about a federal task force's criticism of tests that screen for prostate cancer should have noted that William J. Catalona of Northwestern University, who voiced support for the screening, receives research funding and honorariums from Beckman Coulter Inc., a manufacturer of the tests in question.
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U.S. Panel Questions Prostate Screening
Even when the test picks up a real cancer, doctors are uncertain what, if anything, men should do about it. Many men simply are monitored closely to see if the tumor shows signs of growing or spreading. Others undergo surgery, radiation and hormone treatments, which often leave them incontinent, impotent and experiencing other complications.
"People say, 'What's the harm in screening?' In fact, there are several ways in which screening can actually be harmful," said Howard L. Parnes of the National Cancer Institute.
Since the task force issued its previous recommendations in 2002, at least eight new studies have been published. Among them was a large Swedish review that found that men age 65 and older who were treated for prostate cancer were no more likely to survive than those who were not.
"If therapy isn't providing meaningful benefit, then how could screening provide benefit?" Calonge said. "And we know that the therapy produces significant harms."
Men younger than 75 should be carefully counseled about the potential risks associated with the test and the lack of evidence about any benefit before getting it, the panel said.
Men at high risk for prostate cancer, such as African Americans and those with a family history of the disease, are the most likely to benefit from PSA screening. But the panel concluded that the evidence remains inconclusive for those men as well.
Several other experts said that the new recommendations strike a careful balance, and that they hope they might discourage large-scale screenings where the risks and benefits are not carefully laid out.
"I think they are right on target," Parnes said.
Others were highly critical, noting that prostate cancer death rates have plummeted in many countries after they instituted widespread PSA screening.
"We have seen a dramatic drop in mortality," said J. Brantley Thrasher, chairman of the urology department at the University of Kansas and a spokesman for the American Urological Association. "They're not paying attention to that."
Others objected to setting an age cutoff, saying men should be evaluated individually.
"Men are living a lot longer and healthier these days. I play golf with 84-year-old guys who beat me all the time," said E. David Crawford, a professor of surgery and radiation at the University of Colorado at Denver. "You have to individualize treatment. If a 75-year-old man is found to have high-grade prostate cancer, it's going to kill him, and we can intervene and do something for him."
Two large studies are underway -- one in the United States and one in Europe -- to answer the question of whether screening reduces mortality.
"If it turns out that PSA screening and aggressive treatment saves lives, maybe all the harm that it has caused is worth it," said Otis W. Brawley, chief medical officer at the American Cancer Society. "If PSA screening does not save lives, then it's clearly not worth it. We just don't know yet."