Prostate testing's dark side: Men who were harmed (AP)

Terry Dyroff's PSA blood test led to a prostate biopsy that didn't find cancer but gave him a life-threatening infection.

In the emergency room, "I didn't sit, I just laid on the floor, I felt so bad," said Dyroff, 65, a retired professor from Silver Spring, Md. "I honestly thought I might be dying."

Donald Weaver was a healthy 74-year-old Kansas farmer until doctors went looking for prostate cancer. A PSA test led to a biopsy and surgery, then a heart attack, organ failure and a coma. His grief-stricken wife took him off life support.

"He died of unnecessary preventive medicine," said his nephew, Dr. Jay Siwek, vice chairman of family medicine at Georgetown University. "Blood tests can kill you."

Since Friday, when a task force of independent scientists said routine PSA testing does more harm than good, urologists who make a living treating prostate cancer have rushed to defend the test, as have patients who believe it saved their lives.

Less visible are men who have been harmed by testing, as Dyroff and Weaver were. The harm is not so much from the test itself but from everything it triggers � biopsies that usually are false alarms, and treatments that leave many men incontinent or impotent for cancers that in most cases were not a threat.

Once a PSA test suggests a problem, many men can't live with the worry that they might have cancer. And once cancer is found, most men feel they have to treat it, usually at the urging of their urologist.

"There are many men who have had serious consequences from treatment. Those stories don't get told and they are not uncommon," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, which thinks the task force reached "an appropriate conclusion" about the PSA test.

"I'm not going to criticize men who believe that their lives have been saved by this test," because that's what doctors have told them, Lichtenfeld said. "If you're sitting there and you wet your pants three times a day, you've got to believe it's worth it, that it saved your life."

Many men who agree to a PSA test do not understand what it is. Some common misconceptions:

� It shows cancer. In fact, PSA is just a measure of inflammation, and it can be elevated for many reasons besides cancer: normal enlargement of the prostate with age, an infection, even recent sex, a strenuous bike ride or horseback riding.

� It's been proven to save lives. Only two large, well-done studies have looked at this, the task force says. The American study found annual screening did not lower the chances of dying of prostate cancer. However, cancer fear is so great, and belief in the value of screening so ingrained, that half the men assigned to the group not offered PSA tests got one anyway. That made comparisons to the group given annual screening difficult. For that reason, some doctors don't believe the study's conclusion.

The other study, conducted in Europe, found a small benefit for certain age groups screened every two to seven years � not annually. However, one Swedish center had such rosy results that scientists think it may have biased the whole study. If that center is excluded, no benefit from the PSA test is seen.

� The task force's stance goes against past advice. Routine PSA testing has been supported by some advocacy groups and by urologists, the doctors who do the tests and treatments. But it has not been pushed by major scientific groups, the American Cancer Society or the government.

� It finds cancer early so you're more likely to survive. About 90 percent of prostate cancers found through screening are early-stage. Most will grow so slowly they will never threaten a man's life, but there's no good way to tell which ones will. Research suggests that tumors causing symptoms are more likely to warrant treatment than those that are not. Also, finding aggressive prostate tumors early may not affect how lethal they prove to be; the PSA test may just let men learn of them sooner than they otherwise would.

The task force said that in the European study, the rate of overdiagnosis from PSA screening � finding cancers that do not need to be treated � was estimated to be as high as 50 percent. Based on that study, 1,410 men would have to be screened, and 48 patients would have to be treated, just to save one life from prostate cancer.

Yet the public perception is that if PSA testing finds a cancer early, it must be good.

"Most people tend to think `if it may help, I'm all for it.' But we don't know if it will help," said Siwek, the Georgetown doctor whose uncle died.

Once a PSA test suggests a problem, "it's hard to stop the conveyor belt or the cascade effect" that leads to more testing and treatment, said Siwek, who also is editor of the journal American Family Physician. "The inclination is, `I've got to do something about it.'"

Dyroff, the retired professor, agreed to a biopsy after a blip in his PSA. Several days later, he ran a high fever, felt weak and faint, and spent three days in the hospital fighting a bloodstream infection. A week later he relapsed and required a combination of intravenous antibiotics to finally recover.

A recent Johns Hopkins University study found surprisingly high rates of hospitalization after prostate biopsies and a 12-fold greater risk of death in those who develop infections.

Tony Masraff, a Houston restaurant owner, reluctantly agreed to a biopsy and then was diagnosed with prostate cancer in 1999. His urologist pushed surgery and balked when Masraff asked about other options such as radiation. After some research, Masraff decided just to monitor his tumor, and has seen his PSA rise very slowly over more than a decade.

Now 74, he hasn't had treatment "and I never will," he said. "I'm not concerned because I don't want the debilitative effects � I don't want to wear a diaper, and I like women."

"There's a huge number of people that are being operated on that don't need treatment," said Masraff, who formed a foundation for research into less invasive options.

The need to find a better screening tool is the real message from the task force, said Dr. Christopher Logothetis, prostate cancer research chief at the University of Texas M.D. Anderson Cancer Center in Houston. It may even be that there are better ways to use the PSA � employing it as a baseline test and tracking its rise over time � that might prove better than annual testing.

"If the debate gets reduced to `there's a right and a wrong,' we will lose what we are being told here, which is to search for the path forward," he said.

The cancer society's Lichtenfeld agreed. "Maybe it's time to listen to evidence instead of hope," he wrote in his blog.

___

Online:

Task force recommendations: http://www.uspreventiveservicestaskforce.org/tfcomment.htm

Task force evidence report: http://bit.ly/ovhKUW

PSA decision guide: http://bit.ly/cXq1QE

___

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement

80 percent of US boys use condoms the first time (AP)

CHICAGO � A surprising 80 percent of teenage boys say they are using condoms the first time they have sex, a government survey found in a powerful sign that decades of efforts to change young people's sexual behavior are taking hold.

But another promising trend � a drop since the 1980s in the number of teenagers having sex � has leveled off.

Boys' condom use may mean they are taking more responsibility for contraception or they are protecting themselves from sexually transmitted diseases, experts say. Or, as one young man said, girls may be drawing the line.

"I'm not sure how much of this is guys thinking they need to use a condom or girls insisting they use a condom," said 17-year-old Olivier Vanasse of Princeton, N.J. "I'd be hesitant to give guys credit for coming up with this on their own."

The study, released Wednesday, is based on interviews with about 4,700 teenagers, ages 15 to 19, conducted from 2006 through 2010. It shows the percentage of boys who said they used condoms the first time they had sex climbed from 71 percent in 2002 to 80 percent in the new survey. In 1988, 55 percent of boys said they used a condom during their first sexual intercourse.

"It comes as a general surprise to people that teenagers in general and teen boys in particular can behave responsibly when it comes to making decisions about sex," said Bill Albert, spokesman for the National Campaign to Prevent Teen and Unplanned Pregnancy. "I think it is surprising."

The survey suggests that condom use continues. Asked if they used a condom the last time they had sex in the previous three months, 75 percent said they did, an increase from 71 percent in 2002.

"We don't think it's a stupid thing to do anymore," said Vanasse, a high school senior and staff writer for http://www.sexetc.org, a project of Rutgers University's Answer, a national sex education organization. "It's just accepted as common sense that you should be using a condom if you're going to be having sex."

Overall, about 43 percent of girls and 42 percent of boys report ever having vaginal intercourse, a rate that is statistically unchanged since 2002. The rates had been declining steadily since 1988, when 51 percent of girls and 60 percent of boys reported that they had had sex.

Albert said those findings also explode myths about teen sex.

"There's the notion that all teenagers are doing it, and that's not the case. In fact, less than half said they've had sex," he said. "And there's no gender gap between the teen boys and the teen girls. There's a myth that guys are out on the prowl, and that's not supported by this data."

Less sex and more contraception are driving down teen births, he said. The U.S. teen birth rate in 2009 � 39 births per 1,000 females � was nearly 40 percent lower than the peak in 1991. It's still a dramatically higher birth rate than in Western Europe, where birth control is less expensive and more accessible to teens.

The new study contains more encouraging news. For the first time, there was no racial difference in the percentage of girls reporting they had had sex. In the past, black females were more likely than whites to be sexually experienced.

"That's due to a drop in black females who are sexually experienced," said the study's lead author, Gladys Martinez, a demographer for the government's National Center for Health Statistics.

Other findings:

� Teens were less likely to have had sex if they lived with both parents, if their mothers hadn't been teen moms themselves, or if their mothers were college graduates.

� Most teens � 70 percent of girls and 56 percent of boys � had their first sex with someone with whom they were "going steady."

� A minority � 16 percent of girls and 28 percent of boys � had their first sex with someone they just met or with whom they were "just friends."

Some teenage girls are trying newer contraceptive methods, even the first time they have sex. A small but growing proportion of girls � 6 percent in the new survey, compared with 2 percent in 2002 � reported using long-acting hormonal methods such as injectable birth control, contraceptive patches or the new contraceptive ring.

The finding on teenage boys' condom use heartened proponents of sex education.

"Boys have really stepped up to the plate in the last 20 years. We've included them in the conversation about teen sex and have seen them as able to be responsible actors, and they've done it for us," said Linda Lindberg, a senior research associate for the Guttmacher Institute. "There's been some shift from the double standard of teaching boys not to ask for sex and teaching girls to say no."

She said it was too soon to see any effect from the Obama administration's move away from abstinence-only sex education to programs that teach pregnancy prevention.

___

Online:

Report: http://www.cdc.gov/NCHS/

___

AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson

Powered By WizardRSS.com | Full Text RSS Feed | Amazon Plugin | Settlement Statement