Prostate Cancer Screening

If you’re a man pushing 50 or 60, its possible your prostate is starting to make its presence known. Part of the male reproductive system, this chestnut-sized gland surrounds the urethra, a canal that empties the bladder. That’s why an enlarged prostate often leads to some mighty annoying urinary problems.

As men age, both benign prostate conditions and prostate cancer are more likely to occur. What can you do to catch prostate cancer early? Digital rectal exams (DREs) and prostate-specific antigen (PSA) blood tests can detect cancer in men without symptoms. But the jury is still out on how early and how often men should have these tests. Two recent large studies indicate that PSA tests save few lives and lead to unnecessary tests and treatment for many men.

DRE involves the doctor inserting a gloved finger into the rectum and feeling the prostate gland through the rectal wall. The PSA test measures blood levels of PSA, a protein produced by the prostate gland. The higher the PSA levels, the more likely cancer is present. Although PSA can be what’s called a tumor marker, increased levels can also be due to other factors.

These are some of the limitations of the PSA test:

• It may detect small tumors that grow slowly and don’t threaten your life.
• It may not make a difference with fast or aggressive tumors.
• It may produce false positive test results, resulting in unnecessary tests and procedures.
• It may produce false negative test results, giving you a false sense of security.

The U.S. Preventive Services Task Force (USPSTF) reviewed the benefits and problems associated with prostate cancer screening. Here’s the conclusion they drew: For men 75 and younger, more evidence is needed before recommending screening. As for those 75 and older? The USPSTF found few benefits. However, those with a life expectancy of more than 10 years might still benefit from testing.

At this time, the American Cancer Society (ACS) doesn’t recommend routine PSA testing. That’s because it’s not yet clear whether it saves lives or whether its benefits outweigh the risks. The American Cancer Society (ACS) suggests that you discuss the benefits and limitations of these tests with your doctor. Then your doctor may offer yearly PSA blood tests and DREs starting:

• At age 50 for men at average risk of prostate cancer and with at least a ten-year life expectancy
• At age 45 for men at high risk of developing prostate cancer (This includes African American men and those with a father, brother, or son who was diagnosed with prostate cancer younger than age 65.)
• At age 40 for men at even higher risk – those with several close relatives who were diagnosed with prostate cancer at an early age5

Discuss any abnormal results with your doctor. You might need other tests, such as urine tests, imaging tests, or a biopsy, to confirm whether or not you have cancer.1

SOURCES

1. Bary, MJ. NEJM. March 18, 2009. “Screening for Prostate Cancer — The Controversy That Refuses to Die” http://content.nejm.org/cgi/content/full/NEJMe0901166?query=TOC
2. National Cancer Institute website. “The Prostate-Specific Antigen (PSA) Test: Questions and Answers”http://www.cancer.gov/cancertopics/factsheet/detection/PSA

1. CTV News website. “Prostate cancer overdiagnosed with PSA test”http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20090310/psa_test_090310/20090310?hub=Health

1. Smith, RA, et al. CA Cancer J Clin 2009; 59:27-41 http://caonline.amcancersoc.org/cgi/content/full/59/1/27

1. ACS website. “American Cancer Society Guidelines for the Early Detection of Cancer.”http://www.cancer.org/docroot/ped/content/ped_2_3x_acs_cancer_detection_guidelines_36.asp