Prostate Cancer: Clarifying the Confusion - Wheaton Franciscan Healthcare

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Published on September 08, 2014

Prostate Cancer Screening: Clarifying the Confusion

Recent research suggests routine prostate cancer screening may actually do more harm than good.

Prostate Cancer Screening

Emerging evidence has prompted many experts, including the American College of Physicians and the U.S. Preventive Services Task Force to recommend against, or at least not to directly support, routine prostate cancer screening for all healthy men.

“Men should no longer automatically undergo prostate cancer screening,” says Dr. Paul Hartlaub, Medical Director of Clinical Quality and Population Health for Wheaton Franciscan Healthcare.

Problems with Accuracy

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. The digital rectal exam (DRE) may also be done as a part of screening. But these tests aren’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 four 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 lead to a cancer diagnosis.

Beyond the Blood Test

Some recent studies suggest routine PSA testing may not save lives. That's because many prostate cancers often grow slowly. The cancer may have little effect on a man's health in his lifetime.

Faulty PSA results can also increase anxiety. They can lead to further testing and possibly unnecessary and potentially harmful treatment such as surgery or radiation. 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, if negative, can ease worries about prostate cancer. This may be invaluable for men highly worried based on increased 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, which may make a difference in a limited number of cases. 

According to the American Urological Association, the controversy over prostate cancer should not focus on the test, but rather how test results influence the decision to treat. The decision to proceed to prostate biopsy should be based not only on elevated PSA but should take into account multiple factors. Not all prostate cancers require immediate treatment; active surveillance, in lieu of immediate treatment, is an option that should be considered for some men.

The Bottom Line

Ultimately, Dr. Hartlaub says, whether a man should have a PSA test is something he'll have to decide for himself after discussing it with his primary health care provider, considering risk factors and weighing his personal preferences.

In making this decision, however, he should understand that the evidence indicates there is very little potential benefit, and significant potential harm when undergoing this screening.

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Prostate Cancer: Clarifying the Confusion