"Prostate Cancer Screening Controversies" By Allen Weiss, MD, MBA, President and CEO

Prostate Cancer Screening Controversies

June 1, 2010 - Father's Day is June 20 and I'd like to share a “present” with all dads, and all the rest of us who honor the men in our lives. This “present” is to help those we want to care for and protect against prostate cancer—the most common serious cancer. Skin cancers are more common but generally not serious, except for melanoma. We must first understand how best to detect prostate cancer.

In the past, a prostate-specific-antigen (PSA) blood test and rectal exam were recommended for men over the age of 50. Those men with a higher risk such as having a positive family history or being African American should begin screening at a younger age such as 45.

PSA is a protein produced by cells in the prostate gland. Normally levels are low in the blood but anything from benign inflammation or enlargement to serious cancer can cause the PSA to be elevated. Levels also rise normally with age so that a seventy year old man's normal level is higher than it was when he was age fifty. The rate of change can be meaningful to a urologist looking for a changing or worsening condition.

In the United States, most men over the age of 50 years have had a PSA test. According to two recent New England Journal of Medicine (NEJM) articles and an accompanying editorial, the problem of over diagnosing and over treatment, which can cause other complications, may be significant.

The controversy about screening is based on a study by the U. S. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trail. This eleven year study included 80,000 American men; it showed no change in the number of deaths from prostate cancer among those who were regularly screened with the blood test and rectal exam. In the same issue of the NEJM, another article with a study involving 182,000 European men found a 20% lowering of prostate cancer deaths.

One important note is that the PSA test was introduced in 1992 and since then the death rate from prostate cancer has fallen about 4% per year starting about five years after the introduction of the test. 95% of male urologists and 78% of male primary care physicians who are over the age 50 have had a PSA. So, physicians themselves believe in early detection.

Overall, no test is perfect and more information is still pending concerning screening for prostate cancer. Prudent men should consult with their physicians to understand the benefits of early detection, as well as the modest limitations of prostate cancer detection. Being informed and diligent this Father's Day is good for dad. There are many effective and relatively safe treatments for prostate cancer, making early detection even more worthwhile.

The more one knows about any illness or condition, the better one is able to take care of oneself. Prostate cancer is a perfect example of an illness which can be largely cured by early detection. This Father's Day, let's help all the men in our lives, particularly the dads who deserve some special recognition.

Past Health Advice Articles

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.