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Physicians debate test to screen for prostate cancer

Otis Brawley (left) and John Petros debated the value of using PSA testing to screen for prostate cancer.

Two Winship Cancer Institute physicians squared off on January 8 in a well-attended debate over the value of using PSA testing to screen for prostate cancer.

Otis Brawley, Emory professor of hematology and medical oncology, Chief Medical Officer of the American Cancer Society, and Winship member, led off the debate arguing that studies show PSA testing to be unreliable and possibly leading to too many diagnoses and unnecessary treatment for prostate cancer.

John Petros, Emory professor of urology and Winship researcher, who treats prostate cancer patients, looked at other studies that show the PSA test to be a valuable screening tool that has helped save lives by detecting prostate cancer in earlier stages.

The prostate specific antigen (PSA) screening is a simple blood test that measures the level of a protein produced by the prostate gland. A higher number could indicate prostate cancer, but the test doesn't differentiate between an aggressive, fast-growing cancer, and one that is so slow-growing it wouldn't threaten a man's life.

Both physicians decried the use of mass screenings that test men without the advice of a doctor, and stressed that patients should be informed of the possible inaccuracies of the test, the risks associated with follow-up testing and the risks and side effects of treatment. 

Petros says he believes in initiating a conversation about PSA screening with patients 50 and older, or younger if they have risk factors for the disease. He says the decision to have routine PSA testing, follow-up tests and prostate cancer treatments, is a very individualized process.

"It comes down to, what do you tell the man standing in front of you?" said Petros. "You have to consider where they are in life and what their goals are, and that varies with every man."

Prostate cancer is the second leading cause of cancer death for American men. Brawley says he's not convinced the PSA test saves lives, but he doesn't rule out its use. Although the U.S. Preventive Services Task Force recently issued a recommendation against PSA screening, the American Cancer Society recommends that men make an "informed decision" about testing with their doctors. 

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