But Dr. Otis W. Brawley, an oncologist at the National Cancer Institute, is convinced the PSA test is dangerous. He's so certain that he's betting his life on it. Dr. Brawley is a prime candidate for prostate cancer. He's 39 and African-American (this cancer often strikes black men early), and two uncles had the disease. Yet he won't even consider taking the test.
"I practice what I preach," Dr. Brawley says. "I believe that when we finally get the studies done, we will find prostate cancer screening will ruin lives, not save them. I really believe that."
PSA screening, he concedes, can pick up tumors before they cause any symptoms. But, he says, early diagnosis doesn't necessarily add years to a patient's life. Instead, he says, the PSA test exposes men to the very real threat of needless treatment. Prostate cancer often grows so slowly that a man will die of something else first.
"Yes, they have cancer, but it was never going to kill them," says Dr. Brawley. "That's the big problem."
Cancer eventually returns in one quarter of patients who have a prostatectomy, negating the benefits of undergoing a major operation. No one, he says, has proven that any patients were actually cured through medical intervention. Their tumors might not have spread anyway, with or without treatment, says Dr. Brawley.
He cites findings published in the Journal of the American Medical Association. Two groups of Swedish patients with early, nonaggressive prostate cancer were followed over 15 years. One group was treated; the other wasn't. The outcome: Absolutely no difference in the death rate.
But Dr. Patrick C. Walsh, chief urologist at Johns Hopkins Hospital and one of the country's most noted authorities, condemns this study. He coauthored the journal's accompanying editorial, which said Swedish men die from prostate cancer at an alarming rate.
Sweden, a country in which screening generally isn't available, has the fourth-highest, age-adjusted death toll in the world. Dr. Walsh argues that many patients with advanced cancer might have been cured if treated earlier.
Dr. Walsh says, however, that the PSA test should be done in conjunction with a digital rectal exam. When used together, the two tests usually find the cancer while it's still confined to the prostate.
"I think every healthy man over age 50 who doesn't want to die of prostate cancer should be tested," says Dr. Walsh. "If they're African-American or have multiple family members with prostate cancer, that age is lowered to between 40 and 50. If they don't care, that's OK. But I think men need to know there's a test out there picking up the disease."