Prostate Cancer Screening: A Complex Decision
Screening for prostate cancer isn't complicated-all it takes is a blood sample. Deciding to do it may not be quite so easy. Recent research suggests such testing may do more harm than good. This emerging evidence has prompted many experts-the latest in line, the American College of Physicians-to rethink routine prostate cancer screening. Men may want to do the same.
Detecting prostate cancer starts with a blood sample. The blood is tested for levels of PSA-a type of protein produced by the prostate. High levels of PSA in the blood may mean prostate cancer is present. But the test isn't always accurate.
A man's PSA levels can fluctuate for many reasons. For instance, elevated PSA levels can be a sign of an inflamed or an enlarged prostate. Certain drugs can also affect the body's levels of PSA.
Another complication: There is no consensus on what's normal for PSA levels in men's blood. At one time, doctors thought levels above 4 nanograms per milliliter pointed to prostate cancer. But some men with the disease were found to have levels below that benchmark. And more PSA doesn't always pan out to a cancer diagnosis. A biopsy of the prostate is often needed.
Some studies suggest routine PSA testing may not save lives. That's because prostate cancer often grows slowly. It can have little effect on a man's health in his lifetime.
Faulty PSA results can also amp up anxiety. They can lead to further testing and possibly unnecessary treatment. Biopsies of the prostate and subsequent care can cause side effects, including infection, pain, and urinary and sexual problems. These may be more problematic than the cancer itself.
On the flip side, PSA testing can ease worries about prostate cancer. That may be invaluable for men at risk for the disease, such as African-Americans and those with a family history. It can also help detect fast-growing tumors early, when they are easier to treat.
These complexities raise questions about the value of PSA testing. Many experts-such as the American College of Physicians and the U.S. Preventive Services Task Force-have changed direction on regular prostate cancer screening recommendations for all middle-aged men. In general, they recommend men talk with their doctors about the pros and cons of PSA testing. The bottom line: Men shouldn't automatically undergo prostate cancer screening.
Always talk with your health care provider to find out more information.