Sometimes, healthcare choices, like many areas of life, are not exactly black and white. That is the case in screenings for prostate cancer.
Several screening methods can be used to help detect prostate cancer, but it is not always easy to determine when the risks of these screenings outweigh the benefits.
Many organizations only recommend the screenings for men with certain elevated risks, and others simply recommend that each patient make an informed decision under the guidance of their doctor.
According to the National Cancer Institute (NCI), there are two main forms of prostate cancer screening.
One is a digital rectal exam (DRE), in which the doctor manually examines the prostate through the rectum to feel for any lumps or abnormalities. In a prostate-specific antigen (PSA) test, a blood test is used to measure for PSA — a substance that is mostly produced by the prostate and may be at elevated levels in men with prostate cancer.
"The level of PSA may also be high in men who have an infection or inflammation of the prostate or benign prostatic hyperplasia (BPH; an enlarged but noncancerous prostate)," explained NCI.
Understanding the Risks
According to the American Cancer Society (ACS), even though screening results can help detect cancer earlier, the situation is more complicated than that, and neither test is completely accurate every time.
False positive tests can show abnormal results when no cancer is present, and normal results can be found when there really is cancer. These unclear results can lead to confusion, anxiety and sometimes to unnecessary procedures like prostate biopsy, says ACS.
Another big concern is that these screenings may detect a cancer that is slow growing and wouldn't necessarily cause any problems, symptoms or pain for the patient.
"But these men may still be treated with either surgery or radiation, either because the doctor can't be sure how quickly the cancer might grow and spread, or because the men are uncomfortable knowing they have cancer and not getting any treatment," ACS explains. "Treatments like surgery and radiation can have urinary, bowel, and/or sexual side effects that may seriously affect a man's quality of life."
Recommendations for Men
Recommendations for prostate cancer screening vary slightly depending on the organization.
The U.S. Preventive Services Task Force recommends against PSA screening for prostate cancer.
The ACS recommends that men make informed decisions about screening after a detailed discussion about risks, benefits and unknowns with their doctor, and that men who do not have this information should not be screened. ACS recommends that men with an average risk of prostate cancer should talk with their doctor at age 50, and those at a higher risk should have the discussion at age 45. Men with an extremely high risk (like men with several immediate relatives who had early prostate cancer) should talk with their doctor at age 40, ACS recommends.
The American Urological Association (AUA) recommends against PSA screening in men younger than 40 and does not recommend routine screening in men with an average risk between the ages of 40 to 54. AUA notes that the greatest benefit of screening appears to be for men ages 55 to 69, and similar to ACS, recommends that these men make a personal decision.
AUA also recommends screening every two years versus annually, and recommends against routine PSA screening for men aged 70 or older, or those with less than a 10- to 15-year life expectancy.
In an interview with dailyRx News, Subhakar Mutyala, MD, of the Scott & White Cancer Institute in central Texas, suggested some questions men should ask their doctor when making a decision about these screenings, including questions about their own personal risk level, details about the tests, details about the prostate and potential next steps.
One point of discussion Dr. Mutyala recommended: "With a negative or low risk test, is there anything I could do to prevent prostate cancer?"
Dr. Mutyala also suggested asking, "If it turns out I have prostate cancer, what are the treatment options for me with my medical history? Is surgery an option? Is radiation an option?"
Dr. Mutyala recommended that patients ask their doctors both why they should get screened, and why they shouldn't get screened.
Through these thorough and detailed discussions, men can be informed about prostate screenings and their options.