When Should You Have Your Prostate Checked?
Prostate cancer screening has become a controversial topic. You may have wondered why your doctor stopped screening you for it. Learn the pros and cons of prostate cancer screening and the risk factors associated with prostate cancer to help you decide whether or not to get screened.
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What is the Prostate Specific Antigen (PSA)?
PSA is a protein that is released from the cells of the prostate gland. Therefore, the more prostate cells, then the higher the PSA level (such as in BPH or prostate cancer). But it’s important to remember that other benign factors can also increase the PSA level transiently:
· Prostatitis, which is inflammation or infection of the prostate
· Manual manipulation of the prostate (digital rectal exams, anal sex, recent ejaculation, recent biopsy of the prostate, anything that physically places pressure on the prostate gland)
· Urinary retention (holding it in or not being able to go)
These conditions only temporarily elevate the PSA. Once the condition has resolved, the PSA typically drops back to its baseline level. Therefore, even benign conditions can elevate the PSA.
But is routine PSA screening a beneficial tool for prostate cancer?
Of note, when we refer to a test as a “routine screen,” we are referring to men without any symptoms. The discussion in this article would be completely different if there are symptoms.
What is Prostate Cancer?
Prostate cancer is the most commonly diagnosed cancer in men, besides non-melanoma skin cancers. Yet it is the 2nd cancer leading cause of death in men in the U.S.
Since the 1990’s, the PSA test was used as a presumed way to screen for prostate cancer, without a lot of research to support its use in this way. There were no studies to show that screening men actually decreased mortality. In medicine, screening tests are only recommended if they make a difference in the end. The thought is: so what if the PSA test detects prostate cancer, if it doesn’t actually save lives in the end? That is the crux of the question.
Two landmark studies involving PSA screening has since changed the way physicians practice:
PSA screening was shown to decrease risk of mortality by 21% in those with cancer in this study. But in order to prevent 1 death from prostate cancer, 1410 men needed to be screened and 48 men treated. It also suggests that the only group of men who may benefit from screening are those between 55 and 69 years old.
This was a study of about 76,000 men that showed screening was associated with a 22% increase in prostate cancer diagnoses (not death) after 7 years of follow-up. Despite this and unlike the ERSPC study above, no difference in mortality was found in this study.
Furthermore, PSA testing can be potentially harmful. Routing screening may result in unnecessary testing, invasive biopsies, surgeries, and yield aggressive treatment complications (such as erectile dysfunction, problems with urination or bowel), that otherwise most men would never need if they weren’t tested in the first place. These consequences can diminish quality of life.
The U.S. Preventative Services Task Force (USPSTF), which is the leading organization that sets screening guidelines for practicing physicians, concluded in 2012 that the harm outweighs benefits in prostate cancer screening. And they recommend against routine PSA screening in all men, regardless of age. When choosing to be screened for prostate cancer, patients would be selecting a higher risk of morbidity (diminished quality of life) for a very small chance of improved mortality.
However, the USPSTF’s recommendation has been criticized by several other medical organizations who report a benefit in screening. And physicians are encouraged to individualize decisions based on each patient after reviewing the pros/cons for each person.