He's played many roles in the movies-- many of them humorous-- but actor Ben Stiller's announcement last week that he'd had prostate cancer is no laughing matter.
"One of the main things I felt was I was really lucky," Stiller said.
Lucky, he says, because an early blood test for prostate-specific antigen, or PSA, detected his prostate cancer before it advanced, and he says, saved his life. But the usefulness of the test is actually controversial in the United States.
"There's absolutely an incredible amount of controversy," said Dr. Mark Plante of the UVM Medical Center. "The PSA is a good test. It's not a great test. It is certainly not a perfect test."
In fact, in 2012, the U.S. Preventive Services Task Force issued guidelines saying men should only have a PSA test if they have urologic symptoms. They gave it a D rating. That's because the test can produce false positives. Doctors say benign conditions can also produce high levels of PSA, but invasive biopsies and other tests are first needed to make that determination.
Nevertheless, Plante says prostate cancer remains the number two cancer killer in men, despite a significant reduction in the death rate.
"Can I say that our improvements in surgical and radiation therapy type treatments ascribes to the almost 50 percent reduction in death rate from prostate cancer? No, no, so PSA is playing a role," Plante said.
So who should have the test and how often? Plante says that's a difficult question. Despite the recommendation from the federal task force, he recommends a conservative approach. He says those at higher risk, including men with a family history and African-Americans, should be screened and followed beginning at the age of 40.
"Clearly there are a number of patients who have an elevated PSA who don't have cancer. I don't think it's as high if you're again conservative. We shouldn't be acting on any one PSA. In fact, we have the luxury of doing a few PSAs," Plante said.
A test that can save a life; Ben Stiller says it saved his. But the question remains: who will it benefit, and do the benefits outweigh the risks?
It's interesting to note that the U.S. Preventive Services Task Force recently announced it plans to re-examine its controversial position on PSA tests. No word on when that will be.
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