By Demetrius M. Parker
Health Communication, Marketing and Media Strategist, Centers for Disease Control and Prevention
Should men get screened for prostate cancer? Each man must decide for himself. That’s why it’s important to talk about screening (testing) with our doctor. While we may be a bit anxious about this conversation, we have to remember that there’s a great deal at stake—our families, our lifestyle and quality of life.
When we take care of our prostate health, we give ourselves the best chance to prevent and control prostate cancer. Research by the United States Preventive Services Task Force (USPSTF), a group of health care experts, shows that men aged 55 to 69 benefit most from screening. Specifically, the USPSTF lists African American men and men with a family history of prostate cancer as higher risk groups. I’m in both of these groups. Are you, your relatives or friends in these high-risk groups? Let’s learn more about our options.
What Is Prostate Cancer Screening?
Cancer screening means getting checked for cancer before it can cause symptoms. The goal of screening for prostate cancer is to find cancer that may be at high risk for spreading if not treated, and to find it early before it spreads.
There is no standard test to screen for prostate cancer. One test that is commonly used to screen for prostate cancer is called a prostate specific antigen (PSA) test. PSA is a substance your prostate makes. This test measures the level of PSA in our blood. If we have prostate cancer, our PSA level may be high. However, here’s the challenge. A high PSA level does not confirm that we have cancer. Our PSA level may also be high for other reasons. We should consider talking with our doctor to understand the possible benefits and harms of PSA testing. Then, we may decide whether to get the test.
Benefits of PSA Testing
A PSA test may have several benefits. Knowing our PSA level can help our doctor determine our prostate cancer risk, and a very low PSA level can be encouraging. Finding prostate cancer early may make treatment easier, and even help save our life.
Harmful Effects of PSA Testing
PSA test results are not always the best measure of whether a man has prostate cancer. While it’s true that a high PSA level can be the first sign of prostate cancer, test results can also be a sign of something much less serious. The most common condition that could elevate PSA levels is an enlarged prostate (benign prostate hyperplasia or BPH). Other causes of high PSA levels include prostate inflammation/infection or trauma. Even ejaculation within 24 hours of the PSA test might cause someone with a borderline high PSA level to have a slightly elevated test result. Also, prostatitis, a swelling and inflammation of the prostate gland, is the most common prostate problem for men younger than 50. Bacteria causes prostatitis. Doctors treat it with antibiotics.
Become Aware of Our Body’s Physical Changes
With all these varying circumstances, it’s helpful for us to become aware of physical changes with our bodies—changes that may signal symptoms of prostate cancer. For example, we may experience difficulty starting urination, weak or interrupted flow of urine, and pain or burning during urination. Experts now recommend that men consider talking with their doctor about these changes.
A Complicated Decision
Most men with prostate cancer are older than 65 years. Autopsy studies have found that the majority of men have some evidence of prostate cancer at death, even though they did not die from the disease. This is another reason to decide with our doctor about testing.
If a screening test finds a slow-growing cancer, some men may decide too early to get unnecessary cancer tests and treatments. Making matters worse, prostate cancer treatment can have serious side effects. We want to avoid unnecessary prostate cancer testing and the possible harmful effects.
For example, PSA testing could result in false positive test results. This occurs when a man has an abnormal PSA test but does not have prostate cancer. Men may then worry about their health.
Another consideration is that a positive PSA test might lead to decisions to have another test, a biopsy, to check to see if the PSA test is high because of prostate cancer. A biopsy involves removing a small piece of tissue from the prostate and looking at it under a microscope. A prostate biopsy can cause pain, blood in the semen or ejaculate, and infection.
Making the decision more complex, Canadian research showed that most prostate cancer screening did not actually help save the lives of men 55 to 74 years old. A European study showed that PSA testing contributed to a small decrease in deaths among men who are 55 to 69 years old. The test helped save 13 lives out of 10,000 tested. So, 9,987 men were tested unnecessarily.
With so many different points to think about and options to consider, it’s tough to make a decision to screen for prostate cancer or to wait and watch for symptoms. That’s why talking with our doctor is the key. Our physician can help us avoid unnecessary tests and treatments and make the choice that fits our life, our personal values, and individual circumstances.