"If it werent for routine PSA https prostate cancer https screening an extra  Americans each year would learn that they had the worst form of the disease a new study suggests. That kind of prostate cancer https  metastatic prostate cancer in which the cancer https spreads to the bone or other parts of the body  is rapidly fatal usually within two years or less. The new study seems to make a powerful argument in favor of PSA testing. It finds that in the three years before widespread PSA testing  men getting their first diagnosis of prostate cancer were three times more likely to learn they had very latestage cancer https than men diagnosed in the most recent three years for which data is available . By not using PSA tests in the vast majority of men you have to accept you are going to increase very serious metastatic disease threefold says study leader Edward Messing MD chief of urology at the University of Rochester Medical Center. In  about  U.S. men were diagnosed with metastatic prostate https cancer https By projecting data from the prePSA era forward Messing calculates that without routine PSA tests  men would have been diagnosed in   an extra  cases of deadly disease. But its not that simple says Barnett Kramer MD MPH associate director for disease prevention at the National Institutes of Health. Studies looking back at cancer trends in a population are very unreliable when it comes to showing what caused those trends. For example Kramer says what if a man got a PSA test when his prostate cancer was in the very earliest stages of metastatic disease Microscopic cancers already have seeded his body. But he would not yet have symptoms or detectable metastatic disease so hed be diagnosed with earlierstage disease. Hes subtracted forever from the men whose first diagnosis was latestage disease even though screening could not save his life. Messing says this misses the point of his study which appears in the online July  issue of the journal Cancer. The reason our study has some meaning is that all a screening test can give you is a shift to lowerstage disease he says. It cant cure the disease and it cant prevent the disease. All it can do is allow you to catch it earlier and give appropriate treatment for the stage of disease you have caught it at. Kramer notes that another study using National Cancer Institute data recently found that latestage prostate cancers declined in men over age  after it was recommended that they stop getting PSA tests. Its highly unlikely that not getting screened prevented these cancers. But it does show how easily false results creep into lookback studies. PSA Screening Controversy The U.S. Preventive Services https Task Force recently recommended against routine PSA screening. At best PSA screening may help one man in  avoid death from prostate cancer after  to  years task force cochair Michael LeFevre MD MSPH of the University of Missouri writes in an email to WebMD. We now know that the PSA test harms many more men in the course of testing and treatment after a positive result. But what about Messings study This study is not a randomized trial and the results dont tell us much about whether screening reduces a mans chances of having metastatic prostate cancer LeFevre notes. Since death from prostate cancer will nearly always be preceded by metastatic disease one would expect a significant decline in metastatic disease to be accompanied by a significant reduction in deaths. But that is not what the clinical trials https show. Messing agrees that his study is not a screening study although he argues that the European trial of PSA screening did indeed show the same reduction in metastatic cancer as his study predicted. And this reduction he says argues strongly in favor of routine PSA tests for all men starting at age  and older and for higher risk men starting in their s. Kramer says Messing is right when he says screening itself doesnt save lives. Only treatment can do that. And the evidence unfortunately shows that prostate cancer treatment https isnt as good as everyone would like it to be. A recent study in the New England Journal of Medicine looked at men whose earlystage prostate cancer was detected by PSA tests. Those treated with radical prostatectomy https  considered the most effective if not the safest treatment  were only about  more likely to be alive  years later than those not treated. And PSA testing carries risks. According to LeFevre  Men with suspicious PSA scores get biopsied but up to  of these biopsies https find no cancer.  Once a biopsy finds cancer theres no way to tell for sure if its going to kill him. Nine out of  U.S. men opt for treatment.  For every  men who get treatment after PSA screening one gets a blood clot https two have a heart attack https or stroke https and up to  become incontinent or have urinary incontinence https  One in  men who gets PSA screening will avoid dying of prostate cancer but one in  will die as a result of surgery. PSA Should Men Get the Test So should men get regular PSA tests Many urologists who often treat men suffering terribly from latestage prostate cancer agree with Messing that they should. But many experts on screening tests who often see doctors fail to accept medical evidence that conflicts with their experience agree with LeFevre that they should not. The American Cancer Society has this advice Men should only get the PSA test after having a detailed talk with a doctor about the benefits and risks of PSA screening."