Dear Ann Landers,
s a physician and researcher at the National Cancer Institute, I was surprised to read your column recommending the PSA test to screen for prostate cancer. That column wandered into one of the biggest medical controversies of our time. Numerous professional organizations and advisory groups, includ-ing the U.S. Preventive Services Task Force and the American Acad-emy of Family Physicians, have recommended against using the PSA for screening men who have not shown any symptoms. It is important to understand that many prostate cancers do not need treatment. Un-fortunately, although we are getting much more proficient at diag-nosing prostate cancer, we are not very good at distinguishing the prostates that need treatment from those that are best left alone. Ten- year follow-ups of patients with prostate cancer who received no treat- I 9 II i ANN LANDERS ment showed very similar outcomes to those who were treated. Treat-ment of prostate cancer is associated with a significant incidence of both incontinence and impotence. A small number of men die from the treatment. Clinical trials are currently taking place to determine the effective-ness of the PSA test. Hopefully, these trials will settle the ongoing de-bate. Until then, please, Ann, let your readers know that a conservative approach is best for some.

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