Prostate cancer has a blood test that can be done to find the disease in its early stages. So why do the American Cancer Society, American Urological Association, American College of Physicians, National Cancer Institute and the American College of Preventive Medicine all recommend against routine screening for prostate cancer? “Prostate cancer is a perplexing type of malignant disease. Its long natural history means that men who receive the diagnosis in their 50s and 60s do not necessarily require treatment. Most of these men neither die prematurely nor have a reduced quality of life if the cancer is left untreated.” —The New England Journal of Medicine
According to a recent article in The New England Journal of Medicine, most men who are diagnosed with prostate cancer in their 50s and 60s would not die earlier or suffer in their quality of life, if their cancers are left untreated. On the other hand, prostate cancer is the second most common cancer in men after skin cancer, and does cause over 27,000 deaths every year in Americans. So what is the truth about prostate cancer and the best advice on prostate cancer screening?
Screening for Prostate Cancer
Prostate-specific antigen (PSA) is the blood test used to screen for prostate cancer and it is usually done along with a digital rectal exam (DRE). Both exams are simple and inexpensive, but they are not very specific. The PSA blood test measures a protein produced by prostate cells that goes up with cancer. The problem is that PSA also goes up with many benign prostate conditions and with increasing age. Since routine prostate screening began in the 1990s, deaths from prostate cancer have decreased, but we do not know if this is due to earlier detection or better treatment.
Why Not Screen for Prostate Cancer?
If you screen for prostate cancer and you have an abnormal PSA, you may decide to have a prostate biopsy. Even if your PSA is twice the normal level, there is only a 50 percent chance that your doctor will find cancer. Prostate biopsy is a surgical procedure and can cause bleeding or infection. About 250,000 men in America are faced with a diagnosis of prostate cancer after biopsy and most elect to have treatment. Here is what you need to consider:
- There is no way to know if you have the more common slow-growing type of prostate cancer or the more dangerous kind. Screening may have discovered a type of cancer that is best left alone.
- Radiation and surgery, the treatments for prostate cancer, can cause sexual dysfunction, impotence, loss of urinary control and other complications such as bleeding, diarrhea and rectal inflammation.
- Although there are several ongoing studies, medical experts can’t say that the benefits of routine prostate screening outweigh the risks from diagnosis and treatments.
Best Advice for Prostate Cancer Screening
There are many new screening tests being evaluated for prostate screening that may eventually be able to tell which men will benefit from treatment and which men are best treated by observation and what is called watchful waiting. Until we have a better screening test, here is advice to consider:
- Educate yourself about prostate cancer and the complications of treatment, and talk to your doctor about what frequency of prostate cancer screening is best for you.
- If you have prostate cancer risk factors, such as family history of prostate cancer, or if you are African American, you should have this discussion with your doctor at age 40.
- If you do not have risk factors for prostate cancer you should have this discussion at age 50.
The truth about prostate cancer screening is that routine, yearly screening is unlikely to save lives until we have better screening tools. Prostate cancer is more dangerous in younger men who may have to live with prostate cancer over a longer period. The best advice is to the weigh the benefits of prostate cancer screening with your doctor and come to a decision together that makes sense for you.
More Advice For Seniors And Caregivers
Although Medicare does cover a yearly PSA screening for all men over age 50, and decisions you make about screening should be discussed with the doctor, many experts agree that it does not make sense to screen men after the age of 75. Prostate cancer increases with age and by age 75 or 80 most men will have some slow growing prostate cancer cells. This may give them a positive PSA, but the vast majority of men at over age 70 with prostate cancer will die from other causes. In these older men, treatment for prostate cancer is usually more dangerous that watchful waiting.