There have been arguments made against the need for prostate cancer screening because prostate cancers occur in older men, are slow growing and are not likely to spread or result in death.
If screening detects these cancers, through an abnormal PSA blood test or a suspicious nodule in the prostate gland on a digital rectal exam (DRE) of the prostate, these men may undergo unnecessary, invasive biopsy procedures and may receive unnecessary treatment for their non-threatening cancer that is best left alone.
Another argument against screening with the PSA blood test is that the test is inaccurate, resulting in unnecessary biopsies to check for the disease. However, multiple international studies indicate that the death rate from prostate cancer has been decreased by 40 percent since the introduction of PSA screenings in the late 1980s.
Fortunately, we aren’t forced to choose only between these two screening options. We now have additional, more sophisticated blood tests that allow us to much more accurately determine if a man with an elevated PSA actually has a potentially lethal prostate cancer. These tests allow us to avoid unnecessary biopsies in men who are unlikely to have a lethal cancer.
Sophisticated MRI scans are also now available that can help us check for potentially lethal tumors in the prostate. Secondly, long-term studies support what is known as active surveillance (AS) for men with low-risk prostate cancer. This involves not treating men with cancers that are low risk for spread or death, instead closely monitoring them for signs that their cancer is progressing. This eliminates unnecessary treatments in men with low-risk cancers. There are strict criteria for using AS and for promptly moving ahead with treatment if the situation changes.
The American Urological Association (AUA) and the United States Preventive Task Force currently recommend prostate cancer screening be offered to men between 55 and 70 with PSA blood test and DRE, and screening should start 40 to 45 for men with a strong family history of prostate cancer.
Gregory Carter, MD, practices at Pisgah Urology in Brevard.
For questions or to schedule an appointment with Dr. Carter, call Pisgah Urology at 828-883-5858.
By Gregory Carter, MD