Just say no to prostate screening.

Some health experts now argue that many men suffering from prostate cancer don't need treatment - they will die of something else before their slow-growing tumor becomes terminal (SN: 6/5/93, p.367).

However, a new study takes that hands-off approach a big step further, arguing against mass screenings for the disease. Men without symptoms are better off avoiding tests for prostate cancer, the second leading cause of cancer death among men, a team of researchers contends.

"In the aggregate, we predict that screening will result in net harm rather than net health improvement," report Murray D. Krahn of the University of Toronto and his colleagues in the Sept. 14 Journal of the American Medical Association.

However, the study has numerous limitations, Gerald W. Chodak of the Louis A. Weiss Memorial Hospital in Chicago warns in the same issue of the journal. Most important, the researchers base their entire analysis on a one-time screening, although physicians recommend that men get tested regularly.

Kahn says the new study suggests that repeated screenings would yield results similar to those from a one-time exam.

The new recommendation also rankles many cancer specialists, who now advise men to be tested regularly to catch the disease in its early stages. Early detection, they argue, increases the chances of survival.

Krahn and his colleagues calculated the risks and benefits of widespread screening for prostate cancer. They analyzed data on, for example, reduced quality of life as a result of treatments, how much screening and treatment extend life, and the cost of testing.

Many individuals who test positive for the cancer and undergo treatment would never have experienced trouble from the disease, they argue. Yet a significant percentage of men who undergo surgery or radiation treatments - common therapies for prostate cancer - experience incontinence and impotence as a result. The risk of such side effects varies greatly, depending on a man's age, the location of his tumor, and the skill of his surgeon.

Moreover, treatment and screening extend a man's life only marginally. Getting one prostate-specific antigen (PSA) assay and a rectal examination increases life expectancy by a mere 0.6 to 1.7 days for men 50 to 70 years old, the authors report.

The PSA assay, frequently used by physicians to test for cancer, measures the concentration in the blood of a protein made in the prostate (SN: 8/8/92, p.94).

Radiation treatment produces fewer side effects than surgery and results in slightly greater life expectancy, they report. Nevertheless, overall, more people suffer from screening than benefit from it, Krahn argues.

The final decision about testing rests with the individual, Krahn acknowledges. "You have to sort out how cancer phobic you are" or how much you dislike medical treatment, he says. "I'd just as soon stay away from doctors....I'm a very treatment phobic person."