Prostate Cancer Screening

As mentioned in the New York Times, the U.S. Preventive Services Task Force recently updated its prostate cancer screening guidelines, reaffirming that evidence is lacking to recommend for or against it, and took an additional new step stating that physicians should not routinely screen for prostate cancer in men over 75. This is in contrast to recommendations by other organizations such as the American Cancer Society that recommends doctors offer a PSA blood test and DRE (digital rectal exam) yearly, beginning at age 50 to men who can be expected to live at least 10 more years, and for men at high risk (African American, family history of prostate cancer) screening should begin at age 45.

Why the difference and what should you do?
On the one hand, in 2007, prostate cancer was the leading cause of new cancers for men and second only to lung cancer for cancer death in men. Organizations like the American Cancer Society who are determined to get rid of all cancer encourage screening. On the other hand, it is not clear that finding and then treating prostate cancer will save one's live. This is likely due to the fact that many prostate cancers are slow growing, and men will often die of something else before the prostate cancer spreads. In addition, treatment for prostate cancer is not without risks and complications, such as problems with urination and sexual function.

There is not right answer here, and it is important that you discuss all screening with your doctor. One key thing to determine is that screening and finding cancer doesn't necessarily mean more testing and treating. For example, you might have a PSA test done that is greater than normal, and determine that before proceeding to further testing (biopsy) you might watch and wait. For this reason, I still recommend screening, but advise caution when addressing a positive test. Based on your individual risks, values, etc. you and your physician can determine how best to proceed.