The Importance of Prostate Cancer Screening
Acknowledging screening flaws
There has been a lot of talk over the last few years regarding the subject of prostate cancer screening. The debate has become heated at times. Several years ago the U.S. Preventative Services Task Force (USPSTF) began advocating against prostate cancer screening arguing far too many men were being over treated. They have a valid point. Currently, the PSA test is the only readily available prostate cancer screening tool. The PSA test is very 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 will perform a DRE to determine if there are any prostate abnormalities and they will also prescribe a round of antibiotics to rule out possible infections. The only way to positively identify and type prostate cancer is with a transrectal ultrasound guided needle biopsy.
The dangers of over screening
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 and this is where the waters get muddy.
Cancer is a scary word and 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, deal with months of incontinence, and risk erectile dysfunction for the rest of their lives trying to rid themselves of asymptomatic indolent cancer that would never affect the quality of their lives, let alone take their lives. Because of this lack of education, the USPSTF does not believe men can be trusted to make their own healthcare decisions.
Screening still saves 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 cured. I admit there are side effects and life will change to a new normal but it is a tradeoff most men are willing to except to be cured.
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. 250k men will be diagnosed with prostate cancer this year in the United States. 30k men will die of this stupid disease. The PSA test may not be perfect but it is all 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 PCA then find a doctor who will. Prostate cancer has very few symptoms until it is too late to cure it.
September 1st is the first day of National Prostate Cancer Awareness Month. Do yourself a favor. Get screened today.
How much do you worry about prostate cancer coming back after treatment?