The Importance of Prostate Screening
When asked about prostate cancer screening or treatment, physicians, public health policymakers, patients and patients’ loved ones often have firm opinions or utter confusion.
Different professional medical organizations and federal government policy boards are all over the map on outlining their positions on this controversial topic.
Prostate screening began in the early 1990s when the PSA test began being used. PSA stands for prostate-specific antigen, and this chemical is leaked into the blood stream by normal prostate cells and prostate cancer cells.
A man with prostate cancer has a rising PSA over time, measured by drawing blood, but other prostate disease problems can also cause the PSA to go up. That is where the confusion lies.
Since we began to screen for and aggressively treat prostate cancer, nationwide mortality has gone down and survivability has improved from 67 percent to 92 percent in more modern times.
Some physicians cite other factors in this improvement, such as general health improvement in older men and the increased use of aspirin and cholesterol-lowering drugs called statins. These medications have been linked to lower rates of prostate and colon cancers.
Also, some physician groups and policy makers fear that the complication rates of treating prostate cancer with radiation or surgery outweigh the improvements in surviving the disease.
Some have used the relative advanced age of these patients (usually 65 and older) to argue against major interventions in curing the disease. The United States Preventative Services Task Force recommended against screening men older than 70 approximately eight years ago, and two years ago the panel recommended against screening at all ages.
There are three facts about prostate cancer that keep the discussion brewing.
First, most men with prostate cancer die of other things. This is true.
It is also true that if a man dies of cancer in the United States, the second-leading cause of that death is prostate cancer. Statistics expressed in language can be confusing.
The third important truth about prostate cancer is that when it is in the organ and not yet spread, it only rarely causes any symptoms.
Therefore, the only way to find it is to look for it.
The only way to look for it is to check what the prostate feels like (a digital rectal exam) and looking at trends in PSA values over time (PSA tests yearly or every other year).
If a problem is found with the DRE and/or with the PSA trend, a urologist should do a biopsy of the prostate, which is an outpatient medical procedure accessed via the rectum. It is uncomfortable and not complication-free, but there is not a better method as of yet. If cancer is found, it is the job of the urologist to prudently and practically guide the patient through a decision of cancer management, considering the patient’s health status and age.
The alternative to screening and disease detection is to ignore a potential cancer killer, and regardless of age, we do not choose this in any other area of medicine in the United States. Physicians generally think it is better to have more information than less information when considering their patients’ problems, and patients generally agree.
The most important part of the recommendations of the American Urological Association is that the individual patient have a discussion with his primary care doctor about all screening activities. The issue boils down to what the patient wants to do for his health.
Dr. Joseph Williams is a board-certified urologist. He completed his surgical internship and residency in urology at the National Naval Medical Center in Bethesda, Md. He spent 10 years in the Navy and is a decorated veteran within the Persian Gulf during Operation Desert Storm and Desert Shield. Dr. Williams is a founding member of the Idaho Urologic Institute in Meridian. Visit IdUrology.com for more information.