Screening for prostate cancer used to be a routine part of a wellness exam for men over 40. But conflicting results found in two major studies have made medical groups reexamine that recommendation, with some saying the risks of unnecessary treatment after screening outweigh the benefits of early detection.

Annual screenings for prostate cancer led to more diagnoses of the disease, but no fewer prostate cancer deaths, according to a 17-year project of the National Cancer Institute, part of the National Institutes of Health. A European study found that screening led to a 20 percent reduction in the rate of death from prostate cancer but also carried a high risk of over-diagnosis.

Routine screening usually consists of a rectal exam and a blood test of the prostate-specific antigen (PSA). But a man with a high PSA may not have cancer, and a man with cancer may not have a high PSA, making it even harder to determine which men with prostate cancer need treatment.

We talked about early detection of prostate cancer with Dr. Mark S. Soloway, professor and chairman of urology at the University of Miami Miller School of Medicine and with UM's Sylvester Comprehensive Cancer Center.

``The most important thing is that prostate cancer is very heterogeneous and it's a wide spectrum of cancer,'' he said. Q: What has changed in recommendations for screening for prostate cancer?

A: There is increasing controversy in the area. The guidelines that different medical groups have taken on the role of PSA vary. The American Urological Association and the American Cancer Society both have come out with position statements advocating that an annual PSA test and a rectal examination of the prostate should be offered to all men over 50 and all men over 40 who have a risk factor, including African Americans, who have a higher rate of death from the disease, and men who have a first-degree relative with prostate cancer.

The guidelines for the U.S. Preventive Services Task Force, primary care physicians and internal medicine groups suggest discussing the pros and cons of PSA testing with patients. They recommend the rectal examination but they say the jury is still out on the benefits of the PSA.

Q: What's the problem in detecting prostate cancer too early?

A: When men hear they have cancer, and their significant others even sometimes more so, right away they think of metastases and death, because that's true for people they know who have had many other cancers. Therefore the fear: prostate cancer. I'm going to die of it. The statistics indicate that the chance of that occurring is not very high at all.

Q: Why would doctors not rush to remove small cancers?

A: Prostate cancer, even in the worst grade, does not grow quickly. It often grows extremely slowly. If one looks at those with Gleason 6, which is the lowest grade, at 10 years the disease-specific survival is well over 95 percent. Gleason 6 prostate cancer does not kill many people. Some people are going to have to have treatment, but it may take five to 10 to 15 years to require treatment.

Q: Is there a way to know when a cancer will be slow or fast-growing?

A: First is the grade of the cancer. The grade goes from 6 to 10 and probably 95 percent of men are going to have a Gleason 6 or a Gleason 7. If it's a Gleason 6, the prognosis is going to be excellent.

Second, does the prostate feel normal? If it feels abnormal, the cancer is probably more extensive within the prostate. Probably 85 percent of men have a normal-feeling prostate at the time of diagnosis.

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