The Oct. 22 Another Voice by University of Minnesota professor Gary Schwitzer criticized Roswell Park’s prostate cancer awareness campaign for saying too little about the controversy about PSA as a screening test. Roswell Park developed the PSA test for prostate cancer early detection and management. PSA has revolutionized the ability to monitor prostate cancer, but the test has many advantages and limitations when used for early detection. Our researchers are working to improve the PSA test to distinguish prostate cancers that are potentially aggressive and life-threatening from those that are clinically insignificant.

I am enmeshed in the ongoing and appropriate debate about PSA and prostate cancer; I chair the National Comprehensive Cancer Network’s Prostate Cancer Treatment Guidelines Committee and sit on the Network’s Prostate Cancer Early Detection Guidelines Committee. Network guidelines (available at

www.NCCN.org

) are the most widely used standards for cancer care. These guidelines are updated at least annually and provide patients access to recommendations by panels of experts that include patient advocates, population scientists, urologists, radiation oncologists and medical oncologists.

I concur with Schwitzer that PSA should not be used as a screening test. We should use PSA, and it performs best if used, for early detection of prostate cancer in men likely to die from an undiagnosed prostate cancer.

For example, if you’re young and at high risk because you’re African American or have a father or brother with the disease, do not await more large studies. If you’re older, low risk and have a normal PSA, stop getting the test when life expectancy falls to 10 years or less.

I believe younger and healthier men benefit from having prostate cancer diagnosed when curable so they may evaluate all options for treatment including active surveillance. We need not return to the pre-PSA era when most men’s prostate cancers were found when they were incurable.

Men with newly diagnosed prostate cancer who come to Roswell Park are counseled:

1. Don’t panic. Prostate cancer grows slowly and is usually highly curable.

2. Don’t rush into decisions. Every man and every cancer is different.

3. Get a third or fourth opinion if necessary to arrive at a decision that makes you feel good.

Roswell Park also established a High Risk Prostate Cancer Clinic for men who have an elevated PSA and would like a Roswell Park expert to evaluate their results and recommend steps. Most importantly, two-thirds of men with elevated PSA values do not have cancer. Sometimes another biopsy may be necessary but often a simple repeat PSA, elimination of non-cancer conditions that cause PSA elevations or careful discussion of risks and benefits obviate the need for more biopsies.

James L. Mohler, M. D., is associate director for Translational Research; chairman, Department of Urology; and professor of Oncology, Roswell Park Cancer Institute.