POV: Is it important to screen for prostate cancer?
Testicular cancer and prostate cancer are two of the most important health issues that males face. In a two-part series, Grady “Sam” Hogue, MD, FAAFP, interim head in Department of Primary Care and Population Health at the Texas A&M University College of Medicine, discusses the importance of screening for these two diseases. Read the importance of screening for testicular cancer here.
“You’re going to do what?” is a common phrase that I have heard uttered when I have suggested a Digital Rectal exam (DRE) as a screening test for prostate cancer.
Other than skin cancer, prostate cancer is the number one cancer among American men, and about 1 in 9 men will be diagnosed with prostate cancer during his lifetime. Knowing the warning signs and the risk and talking to your physician about weighing the pros and cons of getting screened are all important measures to take.
It is a fact that you are at a higher risk of getting prostate cancer due to three factors: age, family history and race. Studies show that up to 46% of men in their 50s will have cancerous cells, and up to 83% of men in their 70s will. You are at a higher risk if a man in your family has had prostate cancer, and African American men are also at a higher risk.
However, there are issues surrounding early screening for prostate cancer. Prostate cancer screening recommendations for early detection have changed, with less emphasis on routine screening than before. The PSA (prostate-specific antigen) test, approved by the Food and Drug Administration (FDA) in the late 1980s, combined with a DRE was, at the time, felt to be the best practice for screening men. However, health officials have found the PSA test may not reduce the chance of dying from prostate cancer, and may give false-positive or false-negative results.
With time, it has become evident that most prostate cancers are non-aggressive or slow-growing, and men usually die due to other causes besides prostate cancer. In fact, the risk of dying from prostate cancer is only 3 percent.
Many times using the PSA test could cause overdiagnosis or overtreatment, which often leads to unwanted side effects, such as lifelong sexual dysfunction and loss of urinary bladder control. The diagnosis by biopsy of the prostrate has infection and significant pain risk as well. Studies also show that the benefits of screening have not been completely transparent.
Currently the most common recommendation is for males, based on their age and life expectancy, to have a discussion with their health care providers regarding the risks versus the benefits of early screening for prostate cancer. The most important thing is to have a conversation with your physician, as it is unclear if the benefits of early screening outweigh the risks for men and depend greatly on his personal situation.
Dr. Hogue is board-certified in family medicine and his emphasis and interests are in adult medicine, preventative care, inpatient hospice, and family medicine resident training. He is an American Academy Family Practice fellow.