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The Pros and Cons of Prostate Cancer Screening

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Updated January 09, 2009

Prostate cancer screening involves the use of testing in men who have no symptoms of the disease. Screening for prostate cancer is now much more widely used than in the past and has gained broad acceptance by many physicians in the United States and a number of other countries. Despite it’s extensive use, it is still important to weigh the pros and cons of screening.

In the past, the only tool that doctors had at their disposal to detect prostate cancer in its early stages was the digital rectal examination (DRE). Today, with the easy availability of the PSA test, men throughout the United States and many other countries can now be screened using two very different and complimentary tests. More information about these two tests and their role in diagnosis.

What Are the Benefits of Prostate Cancer Screening?

  1. Many men who have early-stage cancer without any symptoms will have their disease detected before it has had time to spread. This is, by far, the most important argument in favor of prostate cancer screening. When cancer is caught while it is still confined to the prostate, nearly 100% of men survive. When it has spread elsewhere, this number drops significantly.

  2. Both the DRE and PSA test are very easy to perform, require little time, and are not associated with any significant risks.

  3. The percentage of men who die annually of their prostate cancer has declined significantly over the past few years. This is thought by many physicians to be due in part to better screening in addition to improved treatment options.

    What Are the Potential Disadvantages of Prostate Cancer Screening?

    Many men will have high PSA results, but not actually have prostate cancer. These men then undergo further, ultimately unnecessary, testing to determine if cancer is present or not.

    Occasionally men will have low PSA levels and a normal DRE, but actually have prostate cancer. In this situation, men will simply be missed by the screening examinations and go longer without needed treatment.

    Some men will have an abnormal PSA or DRE, be correctly diagnosed with prostate cancer, and then appropriately treated, but will actually have disease that would have never spread fast enough to cause them harm. It is a fact that some men have prostate cancer that is never aggressive and will not kill them. Unfortunately, it is currently not possibly to tell who these men are in advance.

    So What’s a Guy to Do?

    Overall, the majority of primary care physicians and prostate cancer specialists favor the use of prostate cancer screening because they feel that the huge benefit of detecting prostate cancer early in many men outweighs the disadvantages listed above.

    Most physicians agree that all men over 50 and men over 45 who have significant risk factors should undergo prostate cancer screening. Some men, however, such as those over the age of 75 and those with significant health problems, likely will not benefit greatly from screening because they are far more likely to pass away from a cause other than prostate cancer.

    In order to make an educated decision about whether screening or any other aspect of diagnosis is right for you, you should talk with your physician.

    Sources:

    Screening for prostate cancer. American College of Physicians. Ann Intern Med 1997; 126:480.

    Screening for prostate cancer: recommendation and rationale. Ann Intern Med 2002; 137:915.

    Tchetgen, MB, Oesterling, JE. The effect of prostatitis, urinary retention, ejaculation, and ambulation on the serum prostate-specific antigen concentration. Urol Clin North Am 1997; 24:283.

    Thompson, IM, Ankerst, DP, Chi, C, et al. Assessing prostate cancer risk: results from the Prostate Cancer Prevention Trial. J Natl Cancer Inst 2006; 98:529.

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