Screening for Prostate Cancer – The Controversy Continues
The controversy surrounding early prostate cancer screening has been raging for decades. It was hoped with two new studies being conducted, one in the US and one in Europe that the controversy would be laid to rest once and for all. However, that was not the case.
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Screening for Prostate Cancer – The Controversy continues
The controversy surrounding early prostate cancer screening has been raging for decades. It was hoped with two new studies being conducted, one in the US and one in Europe that the controversy would be laid to rest once and for all. However, that was not the case. The two studies raised more questions than they answered.
Screening for prostate cancer consists of a blood test of PSA (prostate-specific antigen) levels and a physical exam known as DRE (digital rectal exam). Currently the American Cancer Society and the American Urology Association does not support routine screening for prostate cancer, but screening should be offered starting at age 50 and earlier if the patient is at high risk for developing prostate cancer. However, a discussion of risks and benefits should occur between the physician and patient where the patient is fully aware of the risk versus benefit ratio. Whereas the U.S. Preventive Services Task Force find no benefit in screening men over the age of 75 and found insufficient evidence to support screening under the age of 75. It was hoped that two studies would unite the opinion of prostate screening and one recommendation could be introduced, but this did not occur.
The US study, the U.S. Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, concluded there was no mortality benefit associated with PSA screening and DRE after an 11 year follow up. The European study, the European Randomized Study of Screening for Prostate Cancer (ERSPC) trial, concluded there was 20% relative reduction in death rate after a 9 year follow up.
What do the studies mean?
At best, routine screening has a moderate impact of decreasing death due to prostate cancer, and has greater impact on over diagnosis and experience of side effects related to treatment.
Most physicians would agree that the answer does not seem to lie in blanket screening with PSA because it cannot determine if the cancer is aggressive and likely to cause death. Most prostate cancers are slow growing and the patient is likely to die from another cause such as heart failure and not prostate cancer. It is agreed that a more specific test is needed to determine aggressiveness of cancer so these can be treated, avoiding the overtreatment and side effects such and incontinence and impotence most men end up experiencing.
What should you do?
The best answer to this question is to discuss with your physician your risk of prostate cancer and if screening would benefit you. If you PSA levels suggest cancer, again discuss with your physician what the test results mean, what are treatment options, what are side effects of treatment, would a watch and wait approach be fitting for your situation, should a biopsy be done to determine if cancer is life threatening or not. Just because your PSA test is positive, is no reason to panic. Write all your questions down and ask your physician. Make sure you are well informed before making any kind of decision and remember, there is not clear cut answer – knowledge is the key.
References
1. content.nejm.org/cgi/content/full/NEJMoa0810696
2. www.ahrq.gov/clinic/uspstf/uspsprca.htm – 11k
3. www.cancer.org/docroot/ped/content/ped_2_3x_acs_cancer_detection_guidelines_36.asp – 31k
4. www.pccnc.org/early_detection/referral_guidelines/ – 12k
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