The problems with prostate cancer.

To screen or not to screen? For prostate cancer, the answer is not easy. Although 15 states have enacted laws mandating insurance coverage for prostate cancer screening with the hope of saving lives, opinions diverge within the medical community on whether men without symptoms should be routinely screened. It is unclear whether screening reduces deaths, or if treatment of early disease is more effective than none in prolonging a man's life. Prostate cancer occurs at an age when other medical conditions such as heart disease and stroke may contribute to the cause of death, so it is unknown how many men will die with prostate cancer rather than from it.

The U.S. Preventive Services Task Force, a federal group that develops prevention guidelines, estimates that one year of mass screening would cost the country $12 billion to $28 billion. The group asserts that the investment would be worthwhile if early detection saves lives. At present there is no clear evidence that it does. "The costs of implementing a screening program are enormous and deflect resources from other uses, such as increased basic science funding to find a cure for this disease," says Dr. Peter C. Albertson, Division of Urology, University of Connecticut Health Center.

"There is a very urgent need to increase research, especially in African American men," who die from this disease nearly twice as often as Caucasians, according to Dr. Charles McDonald, president-elect of the American Cancer Society (ACS). He cites the need for more information about its cause, its risk factors and how to prevent and treat it. The organization estimates that nearly 185,000 men will be diagnosed this year with prostate cancer, the most commonly diagnosed form of cancer (not including skin cancer) among men in the United States. The ACS recommends that screening should be offered annually, beginning at age 50 to men who have at least a 10-year life expectancy, and to younger men who are at high risk. However, the Centers for Disease Control and Prevention and the National Cancer Institute do not recommend screening for men without symptoms.

Alaska, Colorado, Delaware, Georgia, Illinois, Louisiana, Kansas, Maine, Minnesota, North Carolina, North Dakota, New Jersey, Tennessee, Texas and Virginia require insurers to cover yearly prostate screening for all men over age 50 and earlier for men at high risk. Illinois and North Dakota specify that plans cover earlier screenings for African American men. In Oklahoma, state employee benefit plans cover treatment for the side effects of prostate surgery, including Viagra.

The U.S. Preventative Services Task Force stresses the need for "informed decision making." Once a man is presented with the options, the decision whether to be screened or not becomes his personal choice. For more information, call Kelly Perez, [phone].