Men should be screened for prostate cancer
Dr. Robert C. Flanigan
Updated: October 14, 2012 12:10PM
A white man has a 1 in 6 chance of being diagnosed with prostate cancer in his lifetime. For an African-American, the risk is 1 in 3.
More than 30,000 men die of prostate cancer each year, making it the second-leading cause of cancer deaths in men.
On the other hand, prostate cancer can be successfully treated when it is caught early and has not spread beyond the prostate. Before PSA testing became available, we typically diagnosed prostate cancer only after a patient experienced symptoms or after his physician felt abnormalities during a digital rectal exam. But by the time the cancer is detected by such means, it is much more likely to have spread beyond the prostate and become much more difficult to treat.
A PSA screening test can result in a diagnosis at an earlier stage, when the cancer has not yet spread beyond the prostate. The test has drawbacks, and has generated considerable controversy. But when appropriately given to the right men, PSA screening can save lives.
The prostate gland is about the size of a walnut in younger men, but can be larger in older men. It makes some of the fluid that protects sperm cells in semen.
PSA (prostate-specific antigen) is a protein produced by prostate cells. The screening test measures levels of PSA in a blood sample. An elevated PSA can be due to prostate cancer, which can be confirmed with a biopsy. But high PSA levels also can indicate non-cancerous conditions, such as an inflamed or enlarged prostate. And even if a biopsy confirms cancer, it’s not always clear whether the cancer should be treated with surgery or radiation. Some prostate cancers grow so slowly that the man would die of other causes before the cancer became lethal. The U.S. Preventive Services Task Force recently recommended against PSA screening because, in its judgment, the benefits “do not outweigh the harms.”
But other expert bodies still endorse PSA screening. The American Urological Association recommends that men be offered PSA screening beginning at age 40. If the PSA is elevated, the decision on whether to have a biopsy should depend on the PSA level, results of a digital rectal exam, the man’s age, overall health, ethnicity, family history and other factors. If a biopsy is performed and cancer is found, the man then should be offered options of care, including close observation or immediate treatment. The option of watchful waiting rather than immediate treatment. These prudent recommendations balance the benefits and risks of PSA testing, and are based on the best available scientific evidence.
The urological association points out that since PSA screening became routine, there has been a 75 percent reduction in the proportion of men with prostate cancer who are diagnosed when the disease has spread beyond the prostate. There has also been a 42 percent reduction of age-adjusted prostate cancer mortality. (These statistics come from the Surveillance, Epidemiology and End Results Registry.) PSA screening can also prevent the severe morbidity of prostate cancer, including significant bone pain, fractured bones and urinary tract obstruction.
PSA screening is far from perfect, and we may need to make adjustments. For example, rather than screening once a year, it may be prudent in some cases to screen every two, three or four years, depending on the patient’s circumstances. But we should not abandon PSA screening. Until a better test is developed, it remains one of our most potent weapons against prostate cancer, and properly administered, it can continue to save thousands of men’s lives.
Dr. Robert C. Flanigan is the Claire R. Speh Professor and chairman of the Department of Urology of Loyola University Chicago Stritch School of Medicine