Two studies fail to end debate on tests for prostate cancer

NEW YORK (AP) — Two big, long-awaited prostate-cancer studies found that screening may save a few lives but perhaps at a high price. The findings are unlikely to end the debate over the usefulness of routine testing.

The two studies — one in Europe and one in the United States — reached different conclusions. In the U.S., where screening is widely used, researchers reported it did not save lives in a study of 76,000 men. In Europe, where the practice isn’t routine, a study of 162,000 found a modest reduction — about seven fewer deaths per 10,000 men screened. But that screening put more men at risk of getting treatments they didn’t need.

The studies are continuing and may eventually provide more definitive answers, researchers said.

In the meantime, experts say men should do what most guidelines advise: Talk to your doctor about the pros and cons of having the tests before deciding whether it is the right choice for you.

The studies were released Wednesday by the New England Journal of Medicine in connection with a conference in Sweden.

“The hope was there that there’d be a clear answer,” said Dr. Michael Barry of Massachusetts General Hospital, who wrote an accompanying editorial in the journal. “What we’re left with is something in between — that the benefit is fairly small ... and the risks are pretty big.”

Prostate cancer is the most common cancer in men in the U.S. and Europe. More than 186,000 cases will be diagnosed this year in American men, and 28,660 will die of the disease.

Screening is done with a blood test that measures prostate specific antigen, or PSA. Levels of PSA can be high for many reasons, and a biopsy is needed to confirm a tumor. Many tumors grow so slowly that they won’t be a threat, but there’s no sure way to tell which are the dangerous ones.

And there’s no agreement on the best treatment approach — “watchful waiting,” surgery, hormone therapy or radiation. The treatments can lead to impotence and incontinence.

No major medical group recommends routine screening because there’s no proof that it actually saves lives. That’s the question the teams of researchers took on when the studies began in the 1990s.

Both groups are reporting their results a few years early. In the U.S., a panel monitoring the research decided there was enough evidence so far that screening wasn’t saving lives and may have been leading to unnecessary treatment with serious side effects.

That study involved 76,693 men ages 55 to 74 from 10 cities. They were assigned to get six annual PSA tests and four digital rectal exams or regular care from their doctors, which could include screening. About half of the men getting usual care ended up getting screened at some point.

After seven to 10 years of follow-up, more cases of prostate cancer were found in the group that got annual screening, but there was no difference between the groups in the number of cancer deaths. The researchers plan to follow all the men for at least 13 years.