Ten prostate cancer experts recently gave their opinions on whether patients should sign an informed consent before PSA testing for prostate cancer – forms just like the ones patients sign before undergoing potentially risky procedures such as surgery.

Why use an informed consent form? Because men having PSA testing for prostate cancer need to understand the ramifications of what happens if the test results are positive, indicating cancer may be present. PSA refers to prostate-specific antigen, a substance made by normal prostate cells, which can be measured in blood. The higher the PSA level, the more likely the chance of prostate cancer. However, the results do not provide a definite diagnosis. Men with a high PSA result are advised to have a biopsy to find out whether or not they have cancer.

The American Cancer Society guidelines on prostate cancer screening specify that the risk and benefit information should be provided to any man having a PSA test. However, many doctors don’t give the information; they just include the PSA test along with other routine blood tests.

The blood PSA test can detect early prostate cancer, before it has had a chance to spread. These days, most prostate cancers are detected by this test. But what led the experts to wonder about informed consents is that they still can’t agree whether early detection is saving many lives.

Each of the prostate cancer experts wrote a short article in a recent issue of the journal Urology (Volume 61, Issue 1:10-12). All agreed that patients should be told about the problems associated with a positive PSA test.

For instance, if the test is positive, a biopsy is needed. Although local anesthesia helps, a biopsy needle placed through the rectum into the prostate gland can be uncomfortable. And most positive tests turn out to be false positives, meaning there is no cancer.

If the biopsy is positive, treatment is recommended. Surgery or radiation are the most common treatments. But these have a high incidence of side effects – including incontinence and impotence.

But, as one author said, “we’re talking about cancer!” He didn’t feel the side effects were enough to outweigh the seriousness of the disease and the need to be tested.

This was countered by several of the other authors who pointed out that prostate cancer is a slow-growing disease and many people who have prostate cancer eventually die of something else instead. In fact there has been no study proving that screening does save lives.

Everyone did agree that if you have prostate cancer and live long enough, it will cause problems and could lead to death. But there is no telling how old you have to be for this to happen.

The experts split fairly evenly on the question of whether patients having a PSA test should sign a formal informed consent document. But almost all agreed that patients should be told that once they enter into PSA testing, they might experience some problems.

Problems would include the anxiety of waiting for the test results, the discomfort of a biopsy, and the potential need for treatment that will likely interfere with their sex lives and possibly lead to incontinence.

On the plus side is the possibility, not yet clearly known, that early detection of prostate cancer can prolong life.

The ACS estimates that 221,000 men will be diagnosed with prostate cancer in 2003. Even though this cancer only occurs in men, it is the most frequently diagnosed cancer in the US. It is more common than breast cancer (213,000 cases) and lung cancer (172,000). But it is far less fatal. Only 29,000 men are expected to die of this cancer in 2003; most will be in their 70s or 80s.