Prostate cancer screening: The debate continues

By Dr. Zachary Klinghoffer, Urologist, Rouge Valley Health System

Early detection of prostate cancer using the prostate-specific antigen (PSA) blood test has remained a controversial topic for several years. The PSA test is often used as a tool to help detect prostate cancer before men develop symptoms, and before the disease has a chance to spread beyond the prostate.

Most groups agree that the decision to screen for prostate cancer with the PSA test should be the result of a detailed discussion between a man, his physician, and any others who may help the decision-making process, such as a spouse, family member or friend. Various decision aid tools are available to help with this process.

The test cannot provide a definite answer as to whether or not a man has prostate cancer.  In general, the higher the number on the PSA test, the higher the chances of having prostate cancer. However, many men with high numbers do not have prostate cancer (this is called a false positive test), while others with low numbers actually do have prostate cancer (this is called a false negative test).

Several large studies released within the past five years have suggested that using the PSA test to screen for prostate cancer can reduce the number of men who die from this disease. However, these benefits do not come without risks. These same studies suggest that, in order to save one man’s life, a very large number would have to be screened.

Furthermore, some men would be diagnosed with, and potentially treated for, less harmful forms of prostate cancer that may never have had any effect on their lifespans. Numerous medical associations in the U.S. and Canada, such as the U.S. Preventative Services Task Force and the Canadian Urological Association, have taken the results of these studies and interpreted them in different ways.

While some take a “men should be screened” or a “men should not be screened” approach, most recognize that the issue is far too complicated to be reduced to a simple “yes” or “no” answer.

As long as a man has been provided with the appropriate information and resources he needs to make a well-informed decision, as well as the time and opportunity to ask questions of his physician, the choice he makes about PSA screening will always be the right one.