Should you get a screening test for prostate cancer?

Prostate cancer is the most common form of cancer in men and the second leading cause of cancer deaths in American males.  In 2010, approximately 217,730 patients are estimated to be diagnosed with this malignancy.  An estimated 32,050 will die of this disease. 

There is much uncertainty about the benefits of screening for prostate cancer.  This is because in some cases, this malignancy does not affect life expectancy.  Another major consideration is the significant side effects that accompany treatments for this disease, such as incontinence and impotence.  This past year, results were published from the federally-funded large PLCO (Prostate Lung Colorectal and Ovarian) Cancer Screening Trial.  Screening for prostate cancer was not found to be associated with a reduced risk of dying from this disease.  At the same time, a different conclusion was derived from a large clinical trial overseas from the European Randomized Study of Screening for Prostate Cancer (ERSPC) study.  Screening there resulted in a 20% reduction in prostate cancer deaths.  Different study designs may account for the opposite results.  However, in the end, the uncertainty remains.

Currently, the American Cancer Society recommends that “asymptomatic men who have at least a 10-year life expectancy have an opportunity to make an informed decision with their health care provider about whether to be screened for prostate cancer, after receiving information about the uncertainties, risks, and potential benefits.”  Men with average risk should be counseled starting at age 50.  Men at higher risk should begin at age 45.  High risk conditions include:  1) having a first-degree family member with prostate cancer before 65 years of age, or 2) of African-American heritage.  Men with an extensive family history may consider starting screening at age 40.

Screening currently involves a blood test for the PSA (prostate specific antigen) tumor marker, either with or without a digital rectal exam.  It is very possible that screening recommendations may change if in the future a test is developed that can accurately distinguish between lethal prostate cancer from the cases that are indolent and require no treatment.  Guidelines could also change if a treatment is discovered that is highly effective and has minimal side effects.  For now, the decision rests between the individual and his health care provider.  Each man should ask himself what he is willing to do if the screening test comes back abnormal.  If the answer is “nothing”, then it is not worth doing any test.