There has been a lot of controversy regarding prostate cancer screening of late.
Most recently, the United States Preventive Services Task Force (USPSTF) made the recommendation that PSA (prostate specific antigen) screening should be stopped as there can be more harm than benefit from using this practice.
What is prostate cancer? The prostate is a gland in men that produces fluid to carry sperm during ejaculation. In some men, this gland develops cancer. This typically occurs in men older than 50. Risk factors for prostate cancer include increasing age and ethnicity (black men are more likely to develop prostate cancer than Hispanic or white men).
Commonly, prostate cancer screening involves two tests: The PSA and a rectal examination. This is typically done annually in men age 50 and older. Prostate cancer screening is not recommended for men who are 75 and older as the risks of screening outweigh the benefits.
First, we should talk about what PSA is. PSA is a protein made by the prostate gland. It can be measured in a blood sample. PSA may be elevated in prostate cancer, and this is why it has been used to screen for the condition. PSA can be elevated in other conditions as well, so a high PSA level does not necessarily mean that a man has prostate cancer.
Rectal examination involves checking the prostate via the rectum where it can be assessed for nodules or enlargement that may suggest cancer.
The controversy has risen from the review of some medical studies that have shown no benefit of screening. Many medical organizations have made recommendations and statements about this topic, including the American Urological Association, USPSTF and the American Cancer Society. It should be noted that, at this time, there is no consensus by experts on whether PSA testing should be done.
Finding prostate cancer early has the benefit for some men of increasing their life span, but this is not the case for everyone. Early diagnosis can also limit the morbidity of advanced disease (or the spread of cancer). However, PSA testing also can lead to false positive tests, which can then lead to biopsies and surgery to remove the prostate. Potential risks of this include bleeding, erectile dysfunction and urinary incontinence.
This confusion between medical professionals puts the patient in a difficult spot. Whom should they trust? I believe the best answer is that each person must make that decision for themselves. This should be with the guidance of their physician, whose job should be to educate their patients on what information is available and whether testing may be appropriate for them.