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From NPR News, this is ALL THINGS CONSIDERED. I'm Audie Cornish. First this hour, we wade into a debate over medical testing - when it's warranted, and when it's not. Today, a federally sponsored task force said men over the age of 50 should not be routinely offered a test for prostate cancer. That's a test the vast majority now get. The American Urological Association called the new guidelines outrageous and irresponsible. And as NPR's Richard Knox reports, it's not the first time this task force has found itself in the middle of a medical controversy.
RICHARD KNOX, BYLINE: The U.S. Preventive Services Task Force is a group of 17 people who are experts in analyzing medical evidence. Nearly three years ago, it kicked up a storm when it said women under 50 shouldn't get routine mammograms. The new prostate cancer guidelines, previewed last fall, are more sweeping. They say men of any age should not routinely get a blood test for PSA. An elevated PSA may signal prostate cancer - or not.
DR. MICHAEL LEFEVRE: Unfortunately, it is often sold as a test that can only do benefit and cannot do harm. And that's, simply, not true.
KNOX: Dr. Michael LeFevre says men generally aren't aware that PSA testing has pros and cons. He's a professor of family practice in Missouri, and a task force member.
LEFEVRE: We see community screenings. We see vans going around advertising: Men, come in, and this is your best chance to avoid a prostate cancer death.
KNOX: But the task force says for every 1,000 men who get a PSA screening test, one may avoid death because of it, but dozens more will get treatments for a cancer that would never have killed them. Nationally, LeFevre says PSA screening leads tens of thousands of men to get needless surgery and radiation while preventing perhaps 14- to 2,800 prostate cancer deaths a year.
LEFEVRE: I don't want to take lightly any one of those lives. And if prostate cancer screening was harmless and nobody suffered the consequences on the opposite side, then you'd say well, why not? But that, unfortunately, is not the case.
KNOX: Dr. William Catalona thinks the task force is dead wrong.
DR. WILLIAM CATALONA: I just think that what they have done is outrageous.
KNOX: He's a Chicago urologist who performs a lot of prostate surgery.
CATALONA: If the guidelines were implemented and if all PSA screening were to stop, there would be thousands of men who unnecessarily would suffer and die from prostate cancer.
KNOX: Catalona acknowledges the task force has an important mission: to weed out unnecessary tests, or say when they're doing more harm than good. But he says they shouldn't throw out the baby with the bathwater. The Preventive Services Task Force has its defenders, too.
DR. OTIS BRAWLEY: I am a prostate cancer doc, and I think they got it right.
KNOX: That's Dr. Otis Brawley. He's chief medical officer of the American Cancer Society. Brawley says prostate cancer is an exception to the rule that the best way to deal with cancer is to find it early and cut it out. Many, if not most, doctors believe that, and most prostate cancer patients do too. Many are convinced they owe their lives to a PSA test. But Brawley says a million American men have been treated for prostate cancer needlessly. Some men have localized prostate cancer that would never kill them, he says. Others have prostate cancer that kills them even when it's caught early. And a third group, well...
BRAWLEY: The real question is, is there a third group of men - and that is men who we can find the disease early and cure them, and give them a cure that they actually needed because the disease was a threat to their life. That third group of men, we still don't know if it exists, and that's the root of this whole question about screening.
KNOX: But as in the mammogram controversy, Brawley thinks the task force leaves itself open to the charge that it's too analytical, even coldhearted. He thinks it needs to do a better job of explaining itself.
BRAWLEY: I will admit to you that I wish the task force wording were a little bit more user-friendly.
KNOX: Instead of saying that doctors should stop doing PSA tests routinely, maybe it should have said that they shouldn't do them automatically. That leaves the door open to a doctor-patient discussion about the pros and cons. And that's exactly what the task force says it wants to do.
Richard Knox, NPR News.
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