Prostate Cancer Screening:
What’s A Man To Do?

Among men in the United States, prostate cancer is the most common form of cancer. The median age of diagnosis is 66, with diagnoses occurring most frequently among men ages 65–74. The 5-year survival rate, at more than 98 percent, is extremely high. However, prostate cancer is the second leading cause of cancer death in men. The median age at death is 80.

The prostate-specific antigen (PSA) test is a simple blood test that measures the amount of PSA in the blood. An elevated PSA level may be an indication of prostate cancer, but it also can be caused by noncancerous prostate conditions, such as an enlarged prostate. Like digital rectal exams (DRE), the PSA test may be able detect prostate cancer at an earlier stage, when treatment can be most effective.

When it comes to PSA screening, there is no perfect answer for all men. Different professional organizations have different recommendations about who should and who should not have a PSA screening test. Several major organizations recommend that men between the ages of 50 (earlier for men at higher risk) and 70 discuss the risks and benefits of PSA screening with their doctors to make the best individual choice for them.

The U.S. Preventive Services Task Force (USPSTF) is a leading organization of doctors and experts on disease that makes recommendations about preventive care. In 2012, the USPSTF recommended against men undergoing PSA screening for prostate cancer, determining that the test’s risks outweighed its potential benefits. Last month, however, the USPSTF revised its position, recommending that men ages 55–69 discuss the pros and cons of PSA testing with their healthcare professionals and make an individual decision based on their personal risk factors and values.

The problem with the PSA screening test is that it has both potential benefits and risks:

• A PSA test may suggest that a man has prostate cancer, but prostate cancer can only be confirmed through a biopsy. Having a biopsy carries certain risks, including the possibility of infection, pain, and bleeding. And most men who undergo a prostate biopsy will learn that they do not have cancer. When a screening test suggests cancer but a biopsy rules out cancer, the test result is known as a false-positive.

• Not all prostate cancers—especially fast-growing cancers—produce much PSA, leading to a test result that does not indicate cancer, a false-negative. A false-negative result may then delay an accurate prostate cancer diagnosis instead of providing early detection.

• A PSA test may detect prostate cancer early, but for men whose prostate cancer is confirmed through biopsy, up to 50% of them have a cancer that will never grow, spread, or cause any problems. Finding these “indolent” cancers is known as overdiagnosis. Overdiagnosis can lead to overtreatment, which is the treatment of cancers that would not cause any problems if left untreated. Treatments for prostate cancer can cause erectile dysfunction and urinary incontinence.

• Once a man is diagnosed with prostate cancer, depending on the situation, he may decide to be treated, or he may undergo a period of active surveillance (sometimes called watchful waiting) to determine whether the cancer is growing or is unlikely to cause harm. Receiving a cancer diagnosis can provoke considerable fear and anxiety, and making a decision about treatment or active surveillance is complicated when the cancer is potentially life-threatening—or not life-threatening.

Our Feel for Yourself: Prostate Conditions Display features lifelike, palpable models
that depict the differences among normal, enlarged, and cancerous prostates.

• A positive PSA test can save a man’s life because of early prostate cancer detection and treatment. The USPTFS estimates that for every 1,000 men who take the test, between 1 and 2 lives will be saved from prostate cancer and up to 50 men will be overdiagnosed with prostate cancer.

Because of the complexity of PSA testing, the decision to participate in prostate cancer screening is a personal choice, and one for each man to make in consultation with his healthcare professional and based on individual risk factors and values. Particularly for men at higher risk of prostate cancer—including black men and men with a family history of prostate cancer—participating in PSA screening can saves lives.

©2018 Health Edco^®