Prostate cancer is one disease in the Grim Reaper’s quiver at the end of our lives. As we all must will die from some cause, it’s worth reflecting on why so much attention should be given to a disease that stands out so obviously as one that kills most very late in life.
A panel of experts in preventive medicine released a draft proposal Tuesday on screening for prostate cancer. “Another one?” you may ask, remembering an earlier recommendation. Don’t worry; we’re here to help you avoid whiplash:
The question is how to find prostate cancer while it is curable, determine its severity, and treat it appropriately, while minimizing the harms of PSA screening. To do so, we don’t need to test less—we need to test smarter.
Several new prostate-cancer tests aim to reduce needless biopsies and unnecessary treatments by sorting out harmless from aggressive tumors.
PSA screening creates more problems than the cancer itself and as a result just about every major organization is no longer recommending routine PSA screening.
Doctors say that for men who are confused about whether to get a PSA test, there is hope. New M.R.I. tests to guide targeted prostate biopsies may help find the most aggressive cancers that require treatment, thus identifying men who do not need to be treated.
The problem is that treating clinicians have historically done a poor job matching the right patients with the right treatments. These trends are starting to change, and a key advance in recent years, championed by many (including us and others at our institution), is active surveillance for men with low-risk prostate cancer.
Evidence shows that screening does more harm than good. Now what?
In 1970 I discovered the prostate-specific antigen, or PSA, which is now the most widely used tool in prostate screenings. But there has been a growing concern about whether the use of the PSA test has led to overdiagnosis and overtreatment, with millions of unnecessary surgeries, complications and deaths.
I’m sure the nuances of A, B, C and D recommendations can be confusing to the public. They can also make it seem as if experts are constantly changing their minds. But this is how we want our experts to react: When new evidence is found, it should be added to older evidence to change our thinking when appropriate.
“Prostate cancer is a serious health problem that affects thousands of men and their families. But before getting a PSA test, all men deserve to know what the science tells us about PSA screening: there is a very small potential benefit and significant potential harms. We encourage clinicians to consider this evidence and not screen their patients with a PSA test unless the individual being screened understands what is known about PSA screening and makes the personal decision that even a small possibility of benefit outweighs the known risk of harms.”
Prostate Cancer can be diagnosed by using a Digital Rectal Exam (DRE) or biopsy of the prostate.
Surprisingly, there is a lot of debate about whether ordering the PSA test for routine annual prostate cancer screening is a good idea. This is partly because of the uniquely slow-moving nature of most cases of prostate cancer. It’s actually possible to live out a healthy life while you have prostate cancer that is not being treated (termed Active Surveillance)—particularly for an older man. But some prostate cancer cases present an immediate threat, and need to be treated.
Some screening tests are used because they have been shown to be helpful both in finding cancers early and decreasing the chance of dying from these cancers. Other tests are used because they have been shown to find cancer in some people; however, it has not been proven in clinical trials that use of these tests will decrease the risk of dying from cancer.