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Who should be screened for prostate cancer?
I have been screened for prostate cancer before, but now my doctor claims it's no longer recommended. Why shouldn't I get a screening test? Will any males over 50 get tested for prostate cancer?
62 yr old, Male
asked Mar 03, 2010 at 10:37AM in Oncology/Cancer
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2Votesanswered Mar 03, 2010 at 12:27PMProstate cancer is very slow growing and generally asymptomatic in the early stages. There is no consensus regarding screening in men over the age of 60 and the American Urological Association recommends that men speak with their doctors about the pros and cons continued screening. On the pro side is early detection or confirmation that the tests do not indicate a cancer. Early detection however has not played out as a significant factor in improved outcomes. This may change as detection technology and treatment advances are made. On the con side is learning you have cancer. The traditional surgery TURP often leaves men impotent. The reality is that at at 65 if you were diagnosed with prostate cancer you are likely to live out your days to a normal life expectancy.
An excellent resource for patients and doctors is: http://www.prostatecancerfoundation.org/ I highly recommend you browse its contents and I would suggest your doctor do the same. -
2Votes
answered Mar 03, 2010 at 12:29PMI would just like to present this fact sheet below from the National Cancer Institute for your perusal. I believe that it is too early , with research still going on, to discourage screening for prostate cancer in males above the age of fifty (50), especially if that person is black (or has a family history of prostate cancer).
The on-going debate is whether screening and early treatment of prostate cancer is actually beneficial to survival.
http://www.cancer.gov/cancertopics/factsheet/Detection/early-prostate -
1Votesanswered Mar 03, 2010 at 12:45PMAll men 45 years and older should be screened for prostate CA as well as BPH.
A yearly PSA blood test is beneficial as a marker. The only people who are complaining are those
who have to pick up the tab(Insurance Companies).
The irony is that those who decide what should and should not be covered are themselves
susceptible to the same Diseases as the rest of us. -
0Votes
answered Mar 03, 2010 at 01:18PMHere are a few resources on Medpedia that may be helpful- the Clinical: Prostate Cancer article has a section on screening: http://wiki.medpedia.com/Clinical:Prostate_Cancer#Screening
TURP refers to Transurethral Resection of the Prostate, and there is also an article on this topic here: http://wiki.medpedia.com/Transurethral_Resection_of_the_Prostate_(TURP). -
2Votes
answered Mar 03, 2010 at 01:34PMWho should be screened? No one, except some with a very high genetic risk, like BRCA in breast cancer.
Francis and Ritz are right.
Over the decades we have seen that the price is too high. In some cancer like breast cancer, it may be that you save a life or two, but you do it at the price of many women being confronted with false-positive intermediate steps in the screening process. The worst finding -and the most interesting- is that breast screening leads to a diagnosis of breast cancer in one third of the diagnosed women, that otherwise never would have been diagnosed as such. They would, unknowingly, have died from other causes, when their time had come. One third! Suffering breastsurgery, chemotherapy and or radiotherapy; just for nearly nothing; that is: to save one or two other women. It is in my opinion unethical and unresponsible to expose so many women, that would not have died from cancer, to a screening procedure that is so unspecific and hazardous. A decade ago, it was either New England Journal of Medicine or British Medical Journal reporting on the price of Cervical Cancer screening. Over the years I have adviced my wife to abstain from these mass screening approaches.
We are just but lucky that the figures with regard to prostate screening have come up early and quickly enough to show it's uselessness and damage.
The one third that was diagnosed breast cancer, and otherwise never would have been diagnosed as such: what happens there, when screening and detection would not have disturbed the natural course? Would these tumours have been slow progressing? Stationary, perhaps? Spontaneously regressing, as we have studied in advanced cancer (Schilder, de Vries, Goodkin and Antoni, 2004) -
2Votes
answered Mar 03, 2010 at 08:50PMClearly, no clear answer as you can tell by the opinions of physicians on this post. There are only a few posts here but you have completely opposite views. Personally (and I mean literally "personally") I lean towards obtaining a baseline PSA in the 40's and then determining the frequency of testing (annual vs. every 5 years) based on family history of poorly differentiated (high Gleason scores) cancer---the type that is more likely going to kill--along with the age of onset in those family members. It is sounding more and more like DRE is a waste of time in detection, but probably offers some help in prognosticating for some reason. -
2Votesanswered Mar 05, 2010 at 04:11AMColleagues,
This is an article I read this morning saying that the " Cancer Society casts doubt on protate tests:
http://news.yahoo.com/s/ap/20100304/ap_on_he_me/us_med_prostate_cancer -
2Votesanswered Mar 06, 2010 at 08:15AMYour doctor is neither right nor wrong. Even though routine annual PSA screening for every individual is no longer recommended, patients with certain risk factors may need close followup PSA testing every few years. Without knowing your risk factors, it would be not be possible to determine if you should have PSA performed. Given the current recommendations, certain men over the age of 50 will and should be screened for prostate cancer with PSA testing.
PSA screening for prostate cancer is a controversial topic in the health care community. While studies from Innsbruck, Austria have suggested improved survival for patients who had undergone PSA screening, others would argue that these findings are simply the result of lead-time bias. Two recent studies on the role of PSA screening reached divergent conclusions on PSA screening (published in NEJM 360;13, 2009). The PLCO trial concluded that PSA screening did not reduce prostate cancer mortality, but the ERSPC trial concluded that PSA screening resulted a 20% reduction in prostate cancer mortality. Such divergent conclusions may be due to methodological problems found in the PLCO trial where 40% of "un-screeened" patients actually had PSA testing done.
Currently, there are different recommendations on prostate cancer screening from the American Urologic Association (AUA) and the American Cancer Society (ACS). While the AUA suggests a baseline PSA at the age of 40 with individualized testing interval depending on the patients' risk factors (see http://www.auanet.org/content/press/press_releases/article.cfm?articleNo=178&WT.mc_id=EML2010AUA), the ACS recommends a careful discussion between doctors and patients regarding the pros and cons of PSA testing. (http://www.cancer.org/docroot/CRI/content/CRI_2_6x_Prostate_Cancer_Early_Detection.asp?sitearea=&level=).
It is important to note that neither organizations state that PSA testing is not longer necessary. Both organization agree that additional research is necessary for us to find better screening tools for prostate cancer.
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The content on or accessible through Medpedia.com is for informational purposes only. Medpedia is not a substitute for professional advice or expert medical services from a qualified health professional.
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