Prostate Cancer Screening: Benefits, Risks, and Reality

I want to talk to you about the importance of prostate cancer screening and share both the benefits and the limitations.

What are the limitations of PSA testing and prostate cancer screening?

There has been a lot of talk over the years regarding the subject of prostate cancer screening. The debate has become heated at times. Years ago the U.S. Preventative Services Task Force (USPSTF) began advocating against prostate cancer screening for certain men, arguing far too many men were being overtreated. They have a valid point.

Here's the issue: the PSA test is limited in diagnosing prostate cancer, as there are many things that can cause elevated PSA. The PSA test cannot tell the difference between BPH, infection, or prostate cancer. The PSA test cannot differentiate between indolent cancer or aggressive cancer.

Because of this, the PSA test is little more than an indicator of a possible problem. Once elevated PSA is detected, urologists can perform a digital rectal exam to determine if there are any prostate abnormalities. They can also prescribe a round of antibiotics to rule out possible infections.

The main way to positively identify and type prostate cancer is with a biopsy.

Why is over-screening and over-treatment a concern?

In my opinion, this is as unnerving to go through as it is to say. Even with a biopsy, there is no guarantee that cancer will be found. Relatively speaking, the prostate is much larger than the core samples removed by the needle. I know men who were not positively diagnosed until their 3rd biopsy. Once cancer has been identified, men must decide on a treatment plan. This is where the waters get muddy.

Cancer is a scary word. Upon receiving a positive diagnosis, most men will do whatever is necessary to rid themselves of the disease. Often times men with non-aggressive slow growing prostate cancer will unnecessarily undergo prostatectomy surgery. They will have their prostate ripped out, potentially deal with months of incontinence, and risk erectile dysfunction for the rest of their lives. They've done this trying to rid themselves of asymptomatic indolent cancer that may never affect the quality of their lives, let alone take their lives.

Because of this lack of education, the USPSTF did not believe men could be trusted to make their own healthcare decisions.

Can screening still save lives?

I am the perfect example of the opposite side of the argument. Without prostate cancer screening, there will be more men diagnosed with late-stage cancer. If prostate cancer is caught early, it most often can be treated. I admit there are side effects and life will change to a new normal. But it is a tradeoff most men are willing to accept.

We don’t need to stop screening men for prostate cancer. We need a better test. We need a test that will differentiate between indolent and aggressive cancer. We need to do a better job of educating men on whether or not treatment is necessary. We need to give men the information they require to make a treatment decision.

The PSA test may not be perfect. But it is a tool we have until something better comes along.

Don't wait until it's too late

Men need to be screened. If insurance will not cover the cost of screening, then we need to demand the screening and pay for it out of our pockets. Our physicians work for us. If a doctor refuses to screen for prostate cancer then find a doctor who will.