Recently the USPSTF (U.S. Preventive Services Task Force) made a recommendation against ANY man getting a PSA for the purposes of detecting prostate cancer. This unleashed an enormous amount of media attention which unfortunately is quite confusing for the average man. Why would such a recommendation be made and what actually is the controversy behind "screening PSA" and detecting prostate cancer in general? Common sense says "if I have cancer I want to know about it". The answer is not so simple but I'll do my best to simplify the issue.
- Fact: approximately 200,000 men get diagnosed with prostate cancer each year and about 30,000 will die from it.
- Fact: Many men die WITH prostate cancer, not from it. Heart disease being the #1 killer.
- Fact: a significant number of prostate cancer that is discovered is slow growing and may never spread and result in death. Therefore, treatment may not be necessary.
- Fact: prostate cancer treatment can result in serious side effects, most commonly impotence, incontinence and bowel (rectal) problems.
The point is that certain prostate cancers do not necessarily require treatment and there is probably a significant over-treatment of prostate cancer. The argument against screening, or looking for prostate cancer in healthy men is that this may result in unnecessary treatment and side effects, where the cancer was never life threatening to begin with.
The problem is that a significant number of men with prostate cancer are cured and actually benefited from being treated. It is also a well known fact that since PSA came into existence (around 1984) there has been a significant decrease in men dying from prostate cancer.
So what is a man to do? Obviously PSA is a useful blood test especially for men at risk (ie African-American men and men with a family history of prostate cancer). I have number of young patients (40's) who were diagnosed with prostate cancer because of PSA which probably saved their lives! And while I agree that all men should not necessarily have a PSA I think it warrants a discussion with your doctor so that you can choose for yourself whether or not to be screened for prostate cancer. In this case educating yourself about the benefits and possible harmful aspect of prostate cancer screening is the best thing you can do. Visit some reliable websites (AUAFoundation is a good one). Discuss this with your doctor so that you can make an informed decision about what to do. If you would like advise about prostate cancer foundation please call 215-563-1199 and schedule a consultation with me.
