Screening for Prevention of Prostate Cancer

The prostate is a walnut-sized gland located between the bladder and the penis. The prostate, along with the seminal vesicles, produces semen, which contains and nourishes sperm and is transported through and out of the urethra during ejaculation. This article focuses on what men can do to diagnose prostate cancer in its earliest stages.

Six of ten prostate cancer cases are diagnosed in men aged 65 or older. The average age at diagnosis is 66. Except for skin cancer, prostate cancer is the most common malignancy in American men. In 2014, an estimated 233,000 men will be diagnosed with prostate cancer and 29,480 will die.

Prostate cancer is the second-leading cause of death of men in the United States. About one man in 36 will die from it. Although it can be serious, most men diagnosed with prostate cancer do not die from it. More than 2.5 million American men with a current or past diagnosis of prostate cancer are alive today.

Most often prostate cancer grows slowly and remains confined to the prostate gland in the early stages. Slow-growing cancer that has not spread beyond the prostate might not cause serious harm and needs minimal or no treatment. Other more aggressive types of prostate cancer grow and spread rapidly.

Early detection of prostate cancer is important because treatment is more likely to be successful when the cancer is confined to the prostate gland.

Screening and Early Detection

Screening tests for early detection of prostate cancer include:

  • Digital Rectal Exam (DRE) to discover abnormalities in texture, shape, or size of the prostate.
  • Prostate-specific antigen (PSA) blood test to detect higher than normal PSA levels, which might indicate inflammation, infection, enlargement, or cancer of the prostate.

Further testing to determine whether prostate cancer is present is undertaken when abnormalities in either of these tests are found.

Although the combination of PSA testing and DRE can help detect prostate cancer in its early stages, there is debate in the medical community about their role in screening healthy men with no symptoms of the disease. Some medical associations recommend prostate cancer screening for healthy men in their 50s (or earlier if they have risk factors). Others advise against screening.

The main rationale for prostate cancer screening is to identify and diagnose prostate cancer at (probably) earlier, more treatable stages. Screening can help find many prostate cancers early.

Arguments against routine screening of healthy men include the lack of 100 percent accuracy of DRE + PSA combination testing. A positive finding of prostate cancer in a man who does not have it (false positive result) or a finding of no prostate cancer in a man who has it (false negative result) cause confusion and anxiety and risk of the cancer spreading in men with false negative results.

A false positive result will likely lead to a prostate biopsy, which has costs and some risk, and prostate biopsy is also associated with some level of false negative results.

Furthermore, a screening test could identify a slow-growing tumor that would never have caused death or even any symptoms, but is then treated with surgery or radiation because the man is uncomfortable knowing he has cancer or the physician cannot tell how quickly it might spread. Prostate cancer treatments can have serious urinary, bowel, and/or sexual side effects.

Should I Be Tested?

Talk to your physician about the advisability of screening tests for prostate cancer.
You can read more about prostate cancer screening at the American Cancer Society website: http://www.cancer. org/cancer/prostatecancer/detailedguide/prostate-cancerdetection