Q&A: Why are Prostate Cancer Screenings Important?
Prostate cancer remains the 2nd leading cause of cancer death for men in the United States. Prostate cancer screening with prostate specific antigen (PSA) testing has been controversial. This has resulted in significant confusion for both patients and primary care physicians about whether to consider screening. While PSA testing allows earlier detection of prostate cancer and there is high-level evidence suggesting improved survival in men who undergo PSA screening, there has also been concern about the overtreatment of men who are diagnosed with lower risk cancers that are slow growing and not life-threatening. Overtreatment may result in unnecessary urinary, sexual or bowel related problems.
What is the PSA test?
The PSA test is a blood test that detects the level of the PSA protein in the body secreted by the prostate into the blood stream. The PSA level can be elevated in men who have prostate cancer, but also sometimes in men with enlarged prostates or with inflammatory conditions or infections of the prostate.
Who should definitely get a PSA test?
There are certain men who are at an elevated risk for prostate cancer. This includes any African-American men and men with a family history of prostate cancer. It is advised that these men strongly consider PSA testing, usually beginning in their 40s.
I don’t have those risk factors for prostate cancer. Should I get a PSA test?
This is an individual decision and one best answered after a discussion with your physician. Men who are older (70-75 and older) and less healthy (less than 10-year life expectancy) probably will not benefit from routine PSA screening for prostate cancer as they are more likely to die of unrelated causes. Men who are age 45 and older and have a life expectancy that exceeds 10 years should at least consider PSA testing and discuss the risks and benefits with their physicians.
What is being done to avoid the overtreatment of low-risk prostate cancer?
It is now possible to differentiate low-risk cancers (that are not life-threatening) from higher risk cancers that will lead to suffering and death. Low-risk cancers are now commonly being managed with active surveillance, an approach of close monitoring rather than curative intervention. This approach decreases the concern that men who undergo PSA testing and screening will be overtreated, but still allows men with higher risk cancers to be detected so they can be offered curative treatment when cure is still possible.
About the Author
Lester S. Borden, Jr., MD is a Urologist with Alliance Urology Specialists and Prostate Cancer Medical Director with Cone Health Cancer Center