Prostate cancer screening- where it stands now

(this post has been updated 11/17/2015)

Prostate cancer is to men what breast cancer is to women in the United States-

• The number 1 diagnosed cancer in men
• The number 2 cause of cancer-related death in men

So, naturally we would like to be able to diagnose it at a stage where the chance for a cure is greatest.

A screening test is a test that is done on a healthy person to detect a disease that is not causing symptoms. 

For breast cancer, that is a mammogram. For prostate cancer, it is a fairly simple blood test to measure a chemical called Prostate-specific antigen, or PSA

 PSA is a protein produced only by the prostate gland; levels in the blood can be elevated by any disease of the prostate, not just cancer. And, in some cases, it can be normal, even in the presence of cancer.

Despite the bleak sounding statistics, we know that most prostate cancers grow so slowly that they will never cause death. And, for cases that are discovered and treated, sometimes the treatment can cause complications worse than would have occurred from the cancer.

So, multiple organizations including the American Cancer Society, and the American Urological Association, have issued guidelines for screening. To simplify, I am listing a composite of the recommendations from them and others, since they are all quite similar.

• Men under 50 years old- screening not recommended (unless high risk, see below)
• Men from age 50 to 70 years old should discuss the benefit versus risk with their physician, and make a decision together
• Black men are at higher risk so should discuss screening with their physician at age 45 years.
• Men whose father or brother had prostate cancer prior to age 65 years, should begin discussions at age 45 years.
• Men age 70 and older do not need screening, because they will unlikely die from prostate cancer.
• Finally, any man whose health status suggests a life expectancy of less than 10-15 years does benefit from  screening.

The goal for cancer screening, other than merely finding a cancer, is to

• increase a person’s chance for cure and survival.
• minimize complications of the screening and treatment

In the case of prostate cancer, screening does not seem to accomplish this. But these, like other screening guidelines, are based on current evidence, so must be reviewed regularly and changed based on new information.

Here are the guidelines as published for patients in the Journal of the AMA with a link to a podcast discussion.

This Guide to Surviving Prostate Cancer 

by Dr. Patrick Walsh

“covers every aspect of prostate cancer, from potential causes including diet to tests for diagnosis, curative treatment, and innovative means of controlling advanced stages of cancer.”