PSA testing guidelines: NBC's Robert Bazell answers readers' questions

By Robert Bazell, NBC News correspondent

Your comments on my Monday posting about the task force’s recommendations on PSA testing are greatly appreciated. 

They were lively, for the most part civilized, and illustrated the complexity of the subject. As the physician in our "Nightly News" report said, “This has been one of the most gut-wrenching aspects of medicine.”

In response to what many people said I want to repeat that these are recommendations made for the entire population based on what the panel sees as the best evidence.  They are intended to serve as a starting point for a conversation between a man and his physician. They are not an absolute declaration about what any one person should do about his health care.

To answer some questions that were raised:

• Some people asked about how the guidelines apply to younger men.  There were no specific recommendations for younger men.  The two big studies of the efficacy of routine testing were done in men in their 50s, 60s and 70s.
• Some asked about guidelines on what to if prostate cancer is detected.  The task force did not discuss that issue.  The panel certainly made no recommendation against treatment.  But its mandate was to assess the utility of routine screening of healthy men.
• As for the question of whether prostate cancer is potentially life threatening, despite Gleason scores and other methods for staging prostate cancer, the issue remains difficult.  Much research is being directed at trying to find a molecular marker that would indicate which prostate cancer poses the greatest threat.
• Others asked why false positives are a bad thing.  False positives -- or in the case of the PSA test even some not-false positives -- can lead to unnecessary treatment, which can have serious side effects.

Click here to read Robert Bazell's earlier piece about the PSA test guidelines.