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Early Prostate Test Little Relief

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A blood test used to screen men for prostate cancer helps in early diagnosis, but doesn’t appear to tellingly lower deaths from the disease, two foreign medical studies have found.
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The new studies come at a time the Urological Society of India is preparing to launch a nationwide prostate disease awareness campaign to encourage men to have themselves screened for prostate disease. The week-long drive is to begin on April 1.

A large US study examining the benefits of the prostate specific antigen (PSA) test found no detectable mortality benefits among men who opted for an annual test in comparison to men who did not undergo PSA screening.

The PSA, a protein made by prostate gland cells, is elevated in prostate cancer.

Another, even larger, seven-country European study has revealed only a 20 per cent reduction in deaths from prostate cancer after screening, but with a high risk of over-diagnosis and potentially risky over-treatment.

The studies, published in the New England Journal of Medicine on Wednesday, have raised a question mark over the belief that early diagnosis of prostate cancer through routine PSA screening will help reduce deaths through early start of treatment.

The US study monitored the health of more than 76,000 men — roughly half of whom received annual PSA tests, while the other half had no recommendation for or against annual prostate cancer screening. At the end of 10 years, there were 92 prostate cancer deaths in the annual PSA test group, and 82 in the usual-care group. The difference between the numbers is not statistically significant.

“(We) want to understand why some prostate cancers are lethal even when found early by annual screening,” said Christine Berg, the senior author of the study at the National Cancer Institutes (NCI) in the US.

“There may be some men who are diagnosed with prostate cancer and have the side effects of treatment, such as impotence or incontinence, with little chance of benefit,” said John Niederhuber, the NCI director.

Earlier studies have suggested that routine PSA screening may lead to diagnosis of prostate cancer in men who would not have otherwise experienced its symptoms — and thus have never known about the disease — throughout their lives.

“Over-diagnosis and over-treatment are probably the most important adverse effects of prostate cancer screening, and are vastly more common than in screening for breast, colorectal or cervical cancer,” Fritz Schroder from the Erasmus Medical Centre in the Netherlands and his colleagues wrote in their report based on tracking the health of more than 162,000 men between the ages of 55 and 69 years.

“Here in India, we’re not advocating the PSA test as a routine screening test to all above 40,” said Rajeev Sood, the head of urology at Ram Manohar Lohia Hospital, New Delhi, and national convener of the prostate disease awareness campaign.

“A digital rectal exam is routinely offered to all men above 40 — we recommend the PSA only when we find evidence for hardness or nodules on the prostate or when a patient has lower urinary tract symptoms,” Sood told The Telegraph.

In a digital rectal exam, a doctor inserts a lubricated and gloved finger into the rectum to feel for any abnormalities.

Under the prostate disease awareness campaign in India, urologists across the country plan to organise special camps, deliver public outreach talks and offer advisory and diagnostic services.

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Sources: The Telegraph (Kolkata, India)

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