Prostate Cancer Screening

Note: Most of this site is removed now, since it was written in October, 1995 and was old. See the links below for up-to-date consideration of this controversial question.

I currently do screen with the PSA test, but only if requested to after the patient reads the handout included below. It is modeled after one written by Dr. Gerald Chodak at the University of Chicago. You are welcome to use or modify it if you like. - Wesley Eastridge, M.D. 6/19/98

The Question: to screen, or not to screen...

Screening for prostate cancer with a rectal exam and the blood test called PSA is an option that some may want and others will not. In fact, doctors disagree over whether or not to recommend it.

Prostate cancer is the second leading cause of cancer death in the U.S., killing 2.5% of American men. Screening can find it before it spreads, offering a chance for cure.

The trouble is, many more men have small, slow growing prostate cancers than deadly ones. Treating these "harmless" cancers offers no benefit, but can be costly both in dollars and in side effects or complications. Furthermore, we do not have a sure way to tell one from the other before surgery. Thus we could cause more harm in treating several men whose cancer never would have hurt them than we would prevent in curing one whose would have. Consider these pros and cons:

For screening:

• Screening does find small, curable cancers.
• Most prostate cancers spread and become incurable before they are found without screening.
• The American Urological Association and the American Cancer Society both recommend yearly screening, or at least offering the screening*.

Against screening:

• No one has proven prostate cancer screening actually saves lives overall.
• Surgery or radiation treatment, if required, causes some men to leak urine or lose sexual function.
• The U.S. Preventive Services Task Force and the National Cancer Institute recommend against screening.

Here are some more considerations:

Because most prostate cancers grow slowly, men aged 50-65 benefit most from screening, and those over 70-75 the least.

Black men or men whose immediate family members have prostate cancer are at increased risk, and might benefit from screening at age 40.

Please understand this important twist:

You may be asked to "watch and wait" if a small cancer is found. If that is emotionally too difficult, consider not screening at all. The reason is that if we biopsied and treated every elevated PSA, we would surely cause more harm than good. Using other criteria, such as age, size of the prostate, and rate of change of PSA over 6 months to a year, we reduce the chance of treating a "benign" cancer (that is, one that never would have caused symptoms). However, we also increase the chance of letting an aggressive cancer spread beyond the prostate. If you can't accept taking this chance, you should not screen for prostate cancer.

by Wesley Eastridge, M.D., 3/97

{*The American Cancer Society updated its guidelines re prostate cancer in September 1997.  These guidelines for physicians state that PSA/DRE testing should be OFFERED annually starting at age 50, to men who have at least a 10-year survival expectancy and to younger men who are at high risk.  Risks & benefits should be explained prior to the testing. ACS does not tell patients whether the test should be accepted or rejected. ACS believes patients should decide for themselves in consultation w/ their doctors.  They do not support routine or mass screenings of uninformed patients.}

Other related internet sites include:

Man to man

the Prostate Cancer page by the American Cancer Society (who does recommend offering PSA screening)

Reports

of the United States Preventive Services Task Force 1996 (who recommend against PSA screening). See the prostate cancer section in the Guide to Clinical Preventive Services book.

The American College of Physicians

Which recommends individual and physician discretion, but favors waiting on better data before encouraging screening.

Cancer News on the Net

Non-physicians may want to see prostate cancer intended for patients, by the National Cancer Institute. Also, a patient-oriented web site is maintained by a Prostate cancer survivor.

These pages on prostate cancer screening were prepared October, 1995 and last updated March 15, 1998 by Wesley Eastridge, M.D.

Dr. Eastridge is a family practitioner in Gate City, Virginia and across the state line in Kingsport, Tennessee in the Tri-Cities region of upper east Tennessee. Please send comments, suggestions or corrections to

go to Wesley's home page