"After years of growing doubt about the value of screening men for prostate cancer a new analysis of existing clinical trial evidence has found that when men between  and  get the prostatespecific antigen PSA test the result is lives saved. In  a New England Journal of Medicine editorialist famously called the debate over PSA testing for prostate cancer the controversy that refuses to die. That comment came with the publication of two clinical trials  one conducted in the United States the second in Europe  that drew two contradictory conclusions on prostate cancer testing. The U.S. undertaking called the Prostate Lung Colorectal and Ovarian Cancer Screening PLCO Trial found that screening men for prostate cancer does not save lives. The European Randomized Study of Screening for Prostate Cancer suggested that screening drove down the rate of deaths from prostate cancer by . In  a federally funded panel of experts on preventive care concluded https there are more risks than benefits to screening American men for prostate cancer with the PSA test. And in April  the U.S. Preventive Services Task Force dumped the decision http squarely into the laps of patients and their doctors. Some men between  and  years of age might well decide to get their PSA checked the task force said. After hearing the ledger of pros and cons however others in that age bracket might just as reasonably skip the screening test the panel concluded. The new research httpannals.orgaimarticlereconcilingeffectsscreeningprostatecancermortalityerspcplcotrials published Monday in the Annals of Internal Medicine now calls those recommendations into question. The authors of the study led by biostatistician Ruth Etzioni of Fred Hutchinson Cancer Research Center in Seattle concluded that screening men over age  can significantly reduce the risk for prostate cancer death. When men who fit the criteria for screening get the PSA test the reduction in deaths due to prostate cancer was between  and  the new study found. But the newly published analysis also underscores that the value of prostate cancer screening rests heavily on which men you screen where and for how long you conduct the clinical trial and how you crunch the numbers. In the end said Vanderbilt University urological surgeon Dr. Sam Chang the new analysis reinforces what urological surgeons and treating physicians have thought all along that PSA screening is helpful. But it is helpful said Chang only when it focuses on the right men  those between  and   and when it is tempered by an understanding that not all worrisome findings are evidence of disease that should be treated aggressively. Sometimes said Chang who was not involved in the newly published article a man will get a problematic PSA test reading and decide not to act on it immediately or aggressively. But knowing there is a decision to be made is probably a better basis for planning than not knowing he added. Over the past five to  years there has been a better understanding by everyone about the harms of overtreatment Chang said. You want to avoid overdiagnosis and overtreatment. Chang underscored that for two groups in particular  African American men and those with a firstdegree relative who died of prostate cancer  knowing is especially important because the risks of aggressive disease in such populations is much higher than for others. Neither group was the subject of special attention in the newly published analysis. In an editorial httpannals.orgaimarticleprostatecancerscreeningtimequestionhowoptimizeratiobenefitsharms published alongside the new analysis Andrew Vickers of Memorial Sloan Kettering Cancer Center also made clear that its what patients and their physicians do after the PSA test that matters most. Unfortunately the way screening has been implemented in the United States leaves much to be desired Vickers wrote. The controversy about PSAbased screening should no longer be whether it can do good but whether we can change our behavior so that it does more good than harm he added. Prostate cancer is the most common nonskin cancer found in men affecting . of  American men according to the Centers for Disease Control  Prevention. In  the latest year for which figures are available  got a diagnosis of prostate cancer and  died of it. But a change in a mans reading on the PSA test is a highly imperfect gauge of trouble approximately  of positive PSA test results are thought to produce falsepositives creating scares that prompt men to get biopsies. And treatment which carries with it a high risk of subsequent difficulties with sexual function urination and bowel movements is often unnecessary because prostate cancers are often so slowgrowing they will never make a man sick. As a result of this growing skepticism about whom to screen for prostate cancer and whether to treat it more and more men are skipping the PSA test. And among those who get it and get back a worrisome finding fewer and fewer are opting to treat it. Earlier this year a longrunning clinical trial http found no evidence that patients who got an early prostate cancer diagnosis and chose active surveillance sometimes called watchful waiting were no more likely to die of the disease than were men who got the same diagnosis and treated it aggressively."