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LIVE FROM THE HEADLINES

Study Raises Concerns Over Cancer Test

Aired July 24, 2003 - 20:51   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

PAULA ZAHN, CNN ANCHOR: A widely used test designed to look for early signs of prostate cancer may not be nearly as accurate as previously thought. A new study says that the PSA blood test misses 82 percent of tumors in men younger than the age of 60. Researchers say the test's accuracy has been overrated because doctors routinely do not confirm what seems to be a healthy reading. The researchers recommend lowering the healthy reading in order to catch more tumors early on.
So are patients getting mixed messages here?

I'm joined tonight from Boston by Dr. Rinaa Punglia. Dr. Punglia led the story. And here in New York with me tonight, I'm joined by philanthropist and prostate cancer survive Michael Milken.

Welcome to both of you.

Doctor, how nervous should patients be, or any men out there, for that matter, about the findings of this study?

DR. RINAA PUNGLIA, BRIGHAM & WOMEN'S HOSPITAL: It's concerning.

We were surprised by the results. Currently doctors use a cutoff of four to then recommend a prostate biopsy. And we found that this threshold actually misses 82 percent of cancers in younger men and 65 percent of cancers in older men. And that's why we're recommending that the threshold actually be lowered to -- or consideration to lowering the threshold be given to 2.6 for younger men.

ZAHN: But none of this is easily done, you have to concede, because you have critics out there that say, by lowering the threshold, you could be leading to unnecessary biopsies, unnecessary treatment. Are they right?

PUNGLIA: No, it's a complicated issue, and they're absolutely right, too.

Any time you lower the threshold, you're going to increase the number of unnecessary biopsies. But that's a tradeoff. And so, actually, what we're recommending is, doctors and patients together decide, one, whether they should get the PSA test, and, two, what to do once a PSA value returns.

ZAHN: Michael, your life was saved by having a PSA test. So, when you hear about the findings of a study like this, what are you thinking? And what would you advise men to do? MICHAEL MILKEN, PROSTATE CANCER SURVIVOR: I think the PSA test is an indication of your condition. I'd advise you to then go visit with your doctor, possibly a urologist, get a digital rectal exam, and then decide what to do. But one of the things, the most diagnosed non-skin cancer is prostate cancer. Thank God we have this test today.

ZAHN: And what are your concerns, though, about people out there who are saying: Wait a minute, not all forms of prostate cancer are fast-growing forms and maybe the treatment is actually worse than living with the disease long term?

MILKEN: Well, I think the first question is, if you have a high PSA -- we're talking over four, over six, over 10 -- that it sure gives you an indication to go get checked and find out do you have an infection, do you have something else that's affecting you. So the purpose of getting a PSA, if you have a high one, is well-served.

Now, the question you've asked today is, what should you do if your PSA is somewhere between two and four? And I think, then, you have to confer with your doctor, an expert, a digital rectal exam, and then decide what to do on an individual case. And one of the decisions that might be made is watchful waiting, come back six months later and see what the results are.

ZAHN: I guess the one thing we all have to acknowledge this evening, that there is no black and white in this discussion.

You talk, Doctor, about the tradeoffs that have to be made in lowering the threshold level. Meanwhile, the debate rages on about the usefulness of this test in the first place. Can you set the record straight tonight?

PUNGLIA: Right. Right.

So we're in a difficult time period, where the results from the randomized screening studies haven't been published yet. Many of us clinicians do feel that PSA testing will turn out to show some benefit in decreasing prostate cancer mortality. But, until we have the results of those studies, we don't know for sure.

ZAHN: You don't think it's such a big deal?

MILKEN: I don't think it's that tough, Paula; 70,000 more men are alive today than was projected in the last 10 years. I'm confident today that I am alive and well and with you today only because I had a PSA test.

(CROSSTALK)

MILKEN: And so I don't think that question is that difficult. The question is, after you've gotten your score, what do you do with it?

ZAHN: That's a valid point. MILKEN: And I think one of the options is, you can wait, get it tested three months later, six months later, find out if it's an infection or some other reason.

And if the score is relatively low and let's say it's somewhere between two and four, you can decide to wait six months. But if -- once again, if you've found that you have a PSA of 20, 30 -- and there are men first-time diagnosed that have PSAs as high as 200...

ZAHN: Wow.

MILKEN: ... you know you're going to go and take some action.

ZAHN: Sure.

Well, we appreciate both of you educating us tonight.

Michael Milken, always good to see you in person.

And, Dr. Punglia, thank you for your time as well.

PUNGLIA: You're welcome.

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