Parade Magazine May 30, 1999 page 14

Is Prostate Cancer Test Reliable?

by Isadore Rosenfeld

A RECENT PIECE I WROTE ABOUT prostate cancer has generated an interesting and passionate response.

The essence of the dissent is that the Prostate Specific Antigen test is unreliable at detecting a malignancy and that there is no proof that treating most prostate cancers is effective.

My recommendation- that PSA testing should be done for all men aged 50 to 70 reflects the opinion of most "establishment" urologists, including those at the hospitals at which I work -- Memorial Sloan-Kettering Cancer Center and the New York Presbyterian Hospital. Here are the critics' specifics:

These are compelling arguments. However, the American Cancer Society recommends testing and treatment for prostate cancer, because 179,000 men in the U.S. will learn they have the disease this year, and 37,000 will die from it. Although many tumors remain innocuous, others grow and spread, and some do so early on. Right now, there is no way to tell which tumor will follow which course. But there is growing evidence that PSA testing has in fact lowered the death rate.

I worry that while I monitor the progress of a cancer, it will suddenly spread. So I inform my patients about the limitations of PSA testing; I tell them prostate cancer is often not life-threatening. Nevertheless, most of them ask for the PSA test because, if they turn out to have cancer, they want it found early enough to be cured.

When I tell them that a third of all men over the age of 50 probably have some form of prostate cancer but that it will cause death in less than 10%, they ask whether I can guarantee that they won't be among that 10%. I can't. So, since neither they nor I want to play Russian roulette with cancer, I recommend PSA testing for all men between 50 and.70.