November 6, 2017

Prostate Cancer Screening – Addressing the Controversy

By Matthew D. Young, MD, MBA

We all learned as children that “a stich in time saves nine” and that “an ounce of prevention is worth a pound of cure.” So, does the same thing always apply to healthcare? The answer is yes… for the most part.

Early detection of disease is the rationale behind screening programs like colonoscopies and mammograms, trying to find problems early and treat them before becoming much bigger problems. In prostate cancer specifically, the idea was to try and diagnose it early on and treat it before it caused other problems.

For many years men would see their primary care doctor or urologist to be screened for prostate cancer with a PSA (prostate specific antigen) blood test and exam. However, in 2012 the United States Preventative Services Task Force (USPSTF), a group of experts working for the Department of Health & Human Services to look at the effectiveness of different preventative services, recommended against routine screening for prostate cancer. They had looked at a number of studies and concluded that efforts to detect prostate cancer early were not saving many lives and in fact leading to harm in many patients.

This led to an uproar in the medical community, with loud complaints from urologists, oncologists and patient advocates. The USPSTF and others responded that most prostate cancers are not life threatening, pointing to their analysis of scientific papers and statistics that the potential harms of prostate cancer screening outweighed the benefits. Thus the controversy.

So what’s a man to do?

Discuss screening with your doctor. There is no question that prostate cancer is very common, with a 1 in 7 lifetime risk of prostate cancer in American men. Most cases of prostate cancer are slow growing and not life threatening. However, some prostate cancers can be life threatening, and it can be difficult to determine which men would most benefit from treatment.

For men that are high risk (a family history of prostate cancer), screening with a PSA and exam are a good idea. There is near universal agreement among medical experts that men with a life expectancy of less than ten years should not be screened for prostate cancer. An update from the USPSTF gives a cautious approval to prostate cancer screening in men age 55-69.

Really it comes down to a conversation with your primary care provider or urologist, discussing the risks and benefits of screening and then deciding if additional testing is needed.

Matthew D. Young, MD, MBA, is the Chief of Urology at Mission Health.

To learn more about Mission Urology, call Victoria Urological Associates at (828) 254-8883.