Prostate test counselling 'vital'

There are fears that widespread introduction of the Prostate Specific Antigen (PSA) test could lead to many unnecessary operations.

Speaking at the European Cancer Conference in Lisbon on Thursday, a leading prostate specialist from the Netherlands, Professor Fritz Schroder, said it was "unethical" to apply the test without first making sure men understood the implications of a positive, or negative, result.

The PSA test looks for chemical markers in the blood - high levels suggest that the man may have a prostate cancer.

However, two-thirds of men with elevated PSA levels don't actually have the disease, as it could mean they have a simple infection or inflammation of the prostate.

In addition, some men who have completely normal PSA readings do turn out to have cancer - so it is certainly not a failsafe.

In the US, widespread PSA testing has vastly increased the number of prostate cancers detected, but very many of these are slow-growing tumours in elderly men, and unlikely to pose a direct threat to life.

Nevertheless, many men went ahead with potentially risky surgery to remove the prostate, or radiotherapy treatment, both of which carry a significant risk of leaving the patient impotent, incontinent, or both.

Vulnerable nerves

This is because the prostate gland, lying just under the bladder, is close to a number of tissues important in continence and sexual function - it is difficult for surgeons or radiologists to avoid damaging these at the same time.

One study following prostate removal surgery patients in the US found that 60% were impotent 18 months after surgery, 8% had complete urinary incontinence, and 40% had occasional genitourinary problems of one sort or the other.

Professor Schroder told the conference: "Powerful, early diagnostic tests cannot be withheld from well-informed men.

"The accent here, however, has to be on well-informed."

In many parts of the world, doctors will often advise patients who are found to have a prostate cancer to wait and see how aggressive the tumour is before opting for prostate removal or radiotherapy.

This "watchful waiting" involves check-ups every few months to see if the tumour has increased in size.