For about 20 years, the experts have debated whether routine screening for prostate cancer does more harm than good. You might ask, “How could it be bad to screen for cancer?” The answer: when the screening test—the Prostate Specific Antigen (PSA) test— has a high rate of false-positive results, which then leads to unnecessary additional testing, risk and worry.
In 2012, the U.S. Preventive Service Task Force recommended that healthy men of all ages not be routinely screened for prostate cancer since the “benefits of such screening do not outweigh the harms.” Both the American Cancer Society (ACS) and the American Urological Association (AUA) established guidelines for when to screen and encourages men to discuss the pros and cons with their healthcare providers based on their unique situation. The Centers for Disease Control stresses the importance of informed decision-making.
Experts agree that good screening tools do not yet exist for the detection of prostate cancer. The two tests most commonly used are the digital rectal exam (DRE) and the prostate specific antigen (PSA) test. The DRE is performed by a healthcare provider inserting a gloved finger into the rectum to estimate the size of the prostate and to feel for lumps or other abnormalities. The PSA test is a blood test that measures the level of PSA, a substance made by the prostate gland. Higher levels are associated with having prostate cancer, but the distinction between “normal” and “abnormal” results is not always clear.
The biggest risk of screening for prostate cancer with the PSA test is that 100-120 of every 1,000 men tested will receive false-positive results, that is, results that suggest there is cancer when there is not. Such a result often leads to having a biopsy, which poses additional risk for infection, bleeding, urinary problems and pain.
PSA levels can be higher in men who have prostate cancer, but certain medications and procedures, an enlarged prostate, and a prostate infection can also cause PSA levels to be higher. Some men simply produce more PSA than others, but that does not mean they have cancer.
There are many factors that go into making an informed decision about screening for prostate cancer, including your family history, age, race, and where you live. If your father, brother or son has been diagnosed with prostate cancer, you are twice as likely to develop the disease. The risk is greater if any of those family members were diagnosed when they were younger than 55 years or if it has affected three or more family members. Sixty-five percent of men diagnosed are over 65 years; the average age at diagnosis is 69.
African-American men are more likely to develop prostate cancer than Caucasian men. Asian men who live in Asia have the lowest risk but if they move to western cultures, their risk increases significantly. Men who live in northern climates where their exposure to sunlight is less during three months of the year tend to have the highest risk of dying from prostate cancer of any U.S. men.
Is Treatment Necessary?
Understanding your risk factors is helpful but it is also important to know that many prostate cancers remain asymptomatic and don’t require treatment. These prostate tumors generally remain very small and if they grow, they grow so slowly that it’s not likely to have any impact during a man’s lifetime.
The U.S. Preventive Taskforce recommends that providers help their patients at higher risk for developing prostate cancer understand that testing may result in more benefit but also exposes them to more risks. Some providers will encourage men at higher risk to be screened at regular intervals and watch for changes (watchful waiting).
When a patient opts to have their prostate biopsied, he will learn if he has cancer in the areas biopsied and what kind of cancer it is (slow-growing or more aggressive). Unfortunately, biopsies can still miss the presence of cancer. There may not be any benefit in treating slow-growing cancer, but treating any form of cancer can expose patients to a whole host of risks. In the case of prostate cancer, treatment can result in erectile dysfunction and urinary incontinence.
Considering Prostate Cancer Screening?
Talk with your healthcare provider about:
- The ACS and AUA guidelines.
- Your risk factors.
- What actions you would take if your PSA level is “high.”
- The risks associated with testing.
Let Us Help You Decide…
Call your KnovaSolutions® nurse or pharmacist—800/355-0885
8 am-5 pm MDT
The Bottom Line
There is no one right answer about screening for prostate cancer, but it is clear that screening is not a sure thing, and can lead to unnecessary testing, risk and worry. KnovaSolutions can help you make an informed decision about screening. Call us today!
The information contained in this newsletter is for general, educational purposes. It should not be considered a replacement for consultation with your healthcare provider. If you have concerns about your health, please contact your healthcare provider.
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