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The controversy over prostate cancer screening

Created date

July 13th, 2009

For such a small gland (it s roughly the size of a walnut), the prostate has a very important job. If a man didn t have a prostate, the sperm couldn t survive, says Thomas L. Griebling, M.D., M.P.H., professor of Urology at the University of Kansas. The main purpose of the prostate is to produce fluid and other compounds that help support sperm survival. About one in six men between ages 60 and 79 will be diagnosed with prostate cancer, and about 25% of cancer-related deaths in men age 80 and above will be caused by prostate cancer. Prostate cancer is very common, and it s more common as men age, says Griebling. If it is discovered early before it spreads outside of the prostate then it can be curable. Looking for prostate cancer To find prostate cancer early, doctors use a digital rectal examination to find hard or suspicious areas of the prostate. Then they look at a blood sample for the amount of a protein called prostate-specific antigen (PSA). Typically, a normal prostate makes a small amount of PSA while a prostate with cancer makes a large amount of PSA. Based on a scale of 1 to 10, a PSA of 4 or more usually leads to the next step, which is a biopsy of the prostate to look for cancer cells. However, a high PSA doesn t always point to cancer. Just because someone has an elevation in their PSA level, it does not mean they have prostate cancer. Part of the problem with PSA is that it s prostate-specific not prostate-cancer-specific, says Griebling. An imperfect screening tool High PSA levels can be the result of an infection of the prostate (prostatitis) or an enlarged prostate (benign prostatic hyperplasia). Intense physical activity, sexual activity, medications, or herbal medicines can all contribute to an elevated PSA as well. Recent research has highlighted the controversy around using PSA to screen for prostate cancer because even though it can catch cancer early, it s not certain whether the test actually saves lives. One study found annual PSA tests detected more prostate cancers but did not lower the death rate. Another study found screening lowered the risk of death by 20%. The National Institutes of Health explains that even if a man is diagnosed with prostate cancer, it may never grow or spread. And although cancer may be detected, it can t be determined whether it is fast- or slow-moving. As a result, choosing whether to treat prostate cancer can be difficult. A man could potentially have treatment that he does not need. And many treatments may have permanent side effects like urinary incontinence and sexual dysfunction. However, there are treatments for those conditions as well, Griebling adds. The American Urological Association cites autopsy studies that show one in three men over the age of 50 have evidence of prostate cancer, but up to 80% of the tumors are microscopic in size or clinically insignificant. Currently, Medicare will pay for a PSA test every year for men age 50 and above. Should you get one? Talk about testing The recommendations on prostate screenings are inconsistent, so that leaves the doctor and patient in a quagmire, says Mark Holden, M.D. The American Urological Association says men age 50 and above should be screened annually, and men at high risk should begin screening at age 40. Men at high risk include those who have a family history of prostate cancer, African-American men, and men who are taking hormone replacement therapy, says Holden. The American Cancer Society (ACS) holds the position that men should have a conversation with their doctor about the benefits and limitations of screening before any testing actually begins. ACS also recommends men talk to their doctor about the pros and cons of early detection and treatment. A panel of private-sector experts in prevention and primary care, the U.S. Preventive Services Task Force, agrees with the ACS. Further, the Task Force recommends against screening for men age 75 and above. Holden says he tends to have a dialogue with patients about whether they should do the screening or not. If so, we talk about what they would do with the outcome if the screening found anything, he says. If you haven t already, talk with your doctor about prostate screening, cancer, and the possible side effects of treatment. Like Holden says, A lot of times, patients want a clear-cut, definitive answer. And this just doesn t have a black or white answer it s all in shades of gray. About one in six men between ages 60 and 79 will be diagnosed with prostate cancer. Prostate problems If you experience any of the following, it could be a sign of a prostate problem, so be sure to talk to your doctor about it. Frequent urge to urinate Need to get up many times during the night to urinate Blood in urine or semen Painful or burning urination Not being able to urinate