What to do about prostate cancer still revolves around a test developed locally at Roswell Park Cancer Institute as the first stage in possible detection and cure.
Roswell Park developed the Prostate-Specific Antigen (PSA) test. Five years ago, the U.S. Preventive Services Task Force - an independent, volunteer panel of national experts in prevention and evidence-based medicine created in 1984 - recommended against men being screened by the PSA test for prostate cancer. The Task Force gave it a "D" rating, saying "there is moderate or high certainty that the service has no net benefit or that the harm outweighs the benefits."
The test is controversial because it has a significant problem with what are called false positives. False positives can lead to more testing, including a prostate biopsy, and possibly unnecessary treatment, both of which can lead to adverse side effects.
However, this week the influential Task Force lifted its opposition, saying the test can slightly reduce an individual's chance of dying from the most common form of cancer in men. Even so, expert groups of doctors have been going back and forth on whether to use the test and, if used, what age group should get the test.
While the test can lead to diagnoses and probably saves some lives, doctors also cannot usually tell whether a patient has a cancer that is fast-growing or slow-growing. There are some groups of men prone to fast-growing tumors, which can be lethal.
Roswell does not always subscribe to the recommendations of the U.S. Preventive Services Task Force, according to Dr. Khurshid Guru, vice chair of urology at Roswell Park.
"You have a look at the patient and it depends on their life expectancy," says Guru. "Usually that's one of the other important criteria we look at, is that if if their life expectancy is over 10 years and where do they stand in their health terms, which is doing to be the generic answer of life expectancy. Are they diabetic? Did they have two strokes? Or, are they so fit and healthy at 70 they're running a marathon."
Ultimately, Guru says, the treatment chosen is the result of physician and patient talking.
"The physician and the patient, together, make the decision because it's not just, as you know well, it's not just one test, it's a package," says Guru. "How elderly the patient is? How's their health status? What is their blood test? These all confer to be looked at together before we recommend things. We kind of agree with them, that's a good change."
Guru says what is most important is that prevention is better than cure, so if there is a problem, it can be taken care of as early as possible without overtreatment.