Experts counter study's claim - men should continue prostate exams

Jan 23 2006

A man has a one in six chance of being diagnosed with prostate cancer. Each year, more than 230,000 men are diagnosed with the disease. Doctors have traditionally recommended two tests for the early detection of prostate cancer; the prostate specific antigen (PSA) test and digital rectal exam (DRE) are used to detect abnormalities with the prostate gland.

To complicate matters, a recent study in the Archives of Internal Medicine suggests these two widely used tests may not reduce the mortality rate for prostate cancer. Researchers of the study reviewed the medical records of men, fitting their study criteria, at 10 Veterans Affairs medical centers in New England. The study looked at the number of men diagnosed with prostate cancer, then looked at how many of those men received a PSA test and/or a DRE prior to their diagnosis. The study purported to find no difference between the survival rates of men who received a test, and those who did not.

Karmanos Cancer Institute prostate specialist and leader of the genitourinary multidisciplinary team, Ulka Vaishampayan, M.D., says the study is a case control comparison and not the randomized prospective clinical trial which is considered the “gold standard” in evidence-based medicine. Dr. Vaishampayan said, “The side effects of the screening tests - for the PSA and DRE - are minimal to none. There is a possibility of detecting the prostate cancer early, and there is no question that the prostate cancer cure rate is higher the earlier the cancer is found.” Dr. Vaishampayan also notes high risk patients may need to couple medication with their prevention screenings. And, the rate of rising PSA level may be even more important than the overall PSA level. Despite the study’s claims, Dr. Vaishampayan recommends that men continue with their regular prostate cancer screening routine.

According to Omer Kucuk, M.D., FACN, an oncologist at the Karmanos Cancer Institute, the study included a relatively small sample of patients. “Researchers have been discussing whether or not prostate cancer screening with PSA and DRE are beneficial,” said Dr. Kucuk. He continued, “However, randomized clinical trials are needed to definitively answer questions regarding the benefit of prostate cancer screening. Fortunately, the results of two large trials should be available in the next few years.”