Is Routine Prostate Cancer Screening Necessary?

Should men be routinely screened for prostate cancer? Recommendations from various health organizations send conflicting messages, leaving men as confused about prostate cancer screening as women are about breast cancer screening. In both cases, overdiagnosis and overtreatment, and the complications they cause, are the unintended side effects of routine screening. The question is, does screening save lives?

In 2008, the U.S. Preventive Services Task Force (USPSTF) recommended against prostate-specific antigen test (PSA) screening for prostate cancer in men aged 75 or older. In 2012, it recommended against screening for the general population.

Why? Because the Task Force found that most cases have a good prognosis even without treatment. A man’s lifetime risk for dying of prostate cancer is only 2.8 percent and very few men die of prostate cancer before age 60. Seventy percent of deaths occur after age 75.

Although older age is the strongest risk factor for prostate cancer, the USPSTF said neither screening nor treatment trials show benefit in men older than 70 years.

According to the Task Force, the PSA test has a high rate of false positive results, which are associated with additional testing, including biopsies, as well as negative psychological effects.

PSA screening has declined and so has prostate cancer incidence, but…

Recent studies show that prostate cancer incidence in men 75 years and older substantially decreased following the 2008 USPSTF recommendation. Since the Task Force’s 2012 recommendation to omit PSA screening from routine primary care for men, both the incidence of early-stage prostate cancer and rates of PSA screening have declined.

Since prostate cancer tends to be slow growing, it’s way too soon to know if these decreases will affect mortality rates down the road.

According to the National Cancer Institute, prostate cancer is second most common cancer in men in the United States, second only to skin cancer. It’s also the second leading cause of cancer deaths in men. Symptoms aren’t always obvious, especially early on. As it advances, it can lead to frequent urination or weak urine flow, but it’s easy to attribute those symptoms to something else.

There’s no specific prostate cancer test. A digital rectal exam can discover lumps or anything else that is unusual. The PSA test measures the blood for PSA, a substance made in the prostate. In men who have prostate cancer, the PSA level may be higher than normal. Other reasons for high PSA levels include infection, inflammation of the prostate, and benign prostatic hyperplasia (BPH or enlarged prostate). If your PSA level is high, a biopsy can determine if it’s caused by prostate cancer.

Prostate cancer can be aggressive, but for most men, it’s a slow-growing cancer. The trouble is, doctors can’t tell which cancers will be slow growing and which will be life threatening.

So, should you get prostate cancer screening?

“While overtreatment can lead to potentially harmful side effects, there are men being diagnosed with advanced disease every day who wish they had been able to catch their cancer earlier. It is important that men be given options when it comes to their health,” Jamie Bearsesaid, CEO of ZERO – The End of Prostate Cancer, said in a press release.

Jay Simhan, M.D., director of urologic trauma, reconstruction, and prosthetics at Einstein Healthcare Network in Pennsylvania, told Care2 of his concerns. “Prior to the release of USPSTF guidelines, prostate cancer screening may have occurred at too high of a rate. Now, however, the pendulum might have swung too far and we might be missing patients with higher grade cancers that need interventions to prevent death.”

S. Adam Ramin, M.D., urologist and medical director of Urology Cancer Specialists in Los Angeles, believes the USPSTF guidelines are doing a disservice to men. “While the guidelines were created with good intentions, there have been some grave consequences for men’s health,” he said.

He told Care2 that less screening will lead to more patients being diagnosed at later stages of prostate cancer.

“The main criticisms associated with screening are that it may lead to too many prostate biopsies in patients with abnormal screening parameters and too many unnecessary prostate cancer treatments in patients with non-aggressive prostate cancer,” he said. “However, the flip side of the coin is that less screening has led to missing the opportunity on curing men with more aggressive prostate cancer.”

In Dr. Ramin’s view, the solution is not to screen less. “The solution is to ‘fine tune’ the parameters for performing prostate biopsies and to resist recommending unnecessary treatment for patients with less aggressive prostate cancer. We already have the tools to perform testing other than prostate biopsies for men with abnormal PSA or rectal exams. These tests are less aggressive than biopsies and include multi-parametric prostate MRI, transrectal ultrasound of prostate, and newer molecular blood testing.”

For men who are diagnosed with prostate cancer, Dr. Ramin explained there are tests that can predict progression of the cancer and the need to provide treatment versus to perform observation protocol. “These tests include genetic testing on the prostate biopsy specimen and further blood testing.”

In Dr. Ramin’s view, doctors should not shy away from screening for prostate cancer. Rather, they should be smarter about how to interpret results and decide on treatment options. He advises men with average risk to have a PSA test and a rectal exam once a year starting age 50, and men with higher risk to have PSA test and a rectal exam starting at age 45.

What are the risk factors for prostate cancer?

These are some of the risk factors listed on the American Cancer Society website:

  • Age: It’s rare in men under age 40, and chances increases after age 50.
  • Race/ethnicity: It occurs more often in African-American men and in Caribbean men of African ancestry than in men of other races. African-American men are more than twice as likely to die of prostate cancer as white men. Prostate cancer occurs less often in Asian-American and Hispanic/Latino men than in non-Hispanic whites.
  • Geography: It’s more common in North America, northwestern Europe, Australia, and Caribbean islands. It’s less common in Asia, Africa, Central America, and South America.
  • Family history: It seems to run in some families, so there may be an inherited or genetic factor.
  • Workplace exposures: There is some evidence that firefighters are exposed to substances (toxic combustion products) that may increase their risk of prostate cancer.

“I strongly recommend that all men discuss the merits of screening with a urologist so they can make the most informed decision as it pertains to their health history,” said Dr. Simhan.

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Photo: jarun011/iStock/Thinkstock

25 comments

W. C
W. C2 years ago

Thanks.

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Siyus Copetallus
Siyus Copetallus2 years ago

Thank you for sharing.

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Nikki Davey
Nikki Davey3 years ago

My husband was refused screening. Doctor felt it was pointless without symptoms.

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james C.
james C3 years ago

Well as someone with Prostate Cancer, I was not offer any type of screening.

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BornBlazed IndicaSeeds

Thai Peppers work for Prostate Cancer and Lung Cancer, Thailand Cancer rates are lowest in the world! Look it up for yourself!

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Manuela C.
Manuela C3 years ago

This is a very biased article based on "expert opinion", aka the worst scientific evidence of all (I don't even know if you could call it evidence). Prostate cancer screening does not save lives (as you can see in this 2013 Cochrane' systematic review - the best scientific evidence, btw: http://www.cochrane.org/CD004720/PROSTATE_screening-for-prostate-cancer), but it damages many lives with the unnecessary additional tests and prostate cancer treatments...

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Donna T.
Donna T3 years ago

thank you

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Ricky T.
Ricky T3 years ago

But even if most prognosis' are good, surely the treatment is crucial to that, ergo letting people know as soon as possible!?

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Muff-Anne York-Haley

It sounds like the screening is OK but the treatments need to be more informed!

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sandra vito
Sandra Vito3 years ago

Thanks

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