Psa Test

The U.S. Preventive Services Task Force is set to recommend that middle-aged men skip routine screening for prostate cancer, according to reports circulating Thursday. The task force, which sets disease prevention policies for the federal government, is scheduled to issue its new recommendations Tuesday, according to the Santa Monica-based Prostate Cancer Foundation. But the New York Times and a weekly newsletter known as the Cancer Letter reported Thursday that the task force would change its position on the widely used PSA test to recommend that men under age 75 forgo it. The chairwoman of the task force, Dr. Virginia Moyer of Baylor College of Medicine in Houston, could not be reached for comment Thursday.

Guidelines limiting PSA screening for prostate cancer detection in older men are widely ignored, researchers said Tuesday, and physicians seem likely to continue to ignore them. Nearly half of all men age 75 and older receive the PSA test from doctors, despite a growing body of evidence that the tests do more harm than good, according to Dr. Scott E. Eggener of the University of Chicago Medical Center. The issue has been in the news lately with the report last week that 81-year-old Warren Buffett, the well-known entrepreneur, was diagnosed with stage 1 prostate cancer and would begin receiving radiation treatment for it. Because stage 1 prostate cancer is very slow-growing, an elderly man is more likely to die of some other cause before the tumor gets large enough to do any damage.

Re "Abandon PSA tests for men, key panel advises," May 22 When I was diagnosed with prostate cancer after a PSA screening and follow-up tests, I was told it could take 15 years to pose a threat. My doctor told me he would recommend doing nothing if I were in my 70s. Because I was 49, it made sense to have surgery right away. Why wait until the cancer spreads, making surgery riskier and more expensive? So I was appalled that the task force recommended dropping this beneficial test based on a 10-year study.

Surgery performed Friday on Baltimore Oriole outfielder Eric Davis reportedly was more significant than anticipated. The Orioles said Davis, who hasn't played since May 25, underwent successful abdominal surgery in which a segment of his right colon was removed and that he is expected to be sidelined for eight weeks. The Baltimore Sun, however, reported Saturday that the scope of the surgery was greater than anticipated and that more than an abscess was removed.

Today's Pharm Report looks at a new bladder drug, a promising vaccine for ear infection, a new test to improve the accuracy of prostate cancer detection, another choice for postmenopausal women, a generic form of the anti-psychotic drug clozapine, and an increase in research on children's medication. * Treating Overactive Bladder: The first new medication in more than 20 years has been approved for the treatment of overactive bladder.

So, to paraphrase Dirty Harry, "Do you feel lucky, punk?" A couple of stories this week have put me in a philosophical state of mind, and when I start feeling that way, I think of Clint Eastwood's Inspector Harry Callahan, one of my favorite philosophers. In fact, Harry's famous movie line was the first thing that came to mind when I read The Times' story Monday on prostate cancer screening for men. The headlines summed it up: "PSA test for prostate cancer should be dropped, task force says.

Cancer lends itself to the realms of myth. Siddhartha Mukherjee gave the disease some regal treatment in the title of his prize-winning book "The Emperor of All Maladies," but cancer's no emperor. It's a beast. Where actual mythological monsters are concerned, cancer is like the Hydra instead of the Kraken - it isn't the latter's strength that suits it, it's the Hydra's horrible ability to multiply its heads each time a hero strikes it with a sword. Or, in another mythic sphere, it possesses the dark intelligence of Tolkien's Sauron, always looming in places where one fears to find it the most.

When my family doctor called five years ago with the news that my PSA levels had spiked, I hung up the phone and did what all of us do. I panicked. I thought, "So this is how I'm going to die. " Then came the delayed second reaction: This can't be right! I'm a teetotaling, nonsmoking, very fit middle-aged baby boomer, a husband and a father of a 13-year-old daughter. This just wasn't in the Tarot cards. Fortunately, I have five or six very close doctor friends, so I called one of them right away.

The U.S. Preventive Services Task Force has released a draft recommendation that PSA tests no longer be used for routine screens for prostate cancer. What is PSA anyway? Prostate-specific antigen is an enzyme of a type called a protease; it cuts up other proteins. Scientists believe it helps liquefy semen, and it may help sperm find its way to an egg by digesting the mucus covering the cervix. When cancers develop in the prostate gland, levels of PSA can start to climb in the blood.

Many people are diagnosed with a condition or even a cancer that won't affect them in any significant way. Medical experts call this "overdiagnosis. " The poster child of overdiagnosis is prostate cancer screening. When the PSA test, which can detect minute quantities of prostate specific antigen in the blood, was introduced nearly 20 years ago, the test became widely used as a routine check for men over age 40. But the test produced a high rate of false positives, and it also exposed benign, microscopic cancers that in many cases led to radiation treatment and surgery.