Prostate Cancer: Early Detection
Screening means checking for a health problem before a person has symptoms. This can sometimes find diseases like certain cancers early, which can lead to early treatment. This may improve the chance that treatment will work better. But it is not clear exactly how helpful screening is for prostate cancer.
Screening tests for prostate cancer
Two screening tests can look for prostate cancer:
PSA blood test. This test looks at the level of prostate-specific antigen (PSA) in the blood. A higher level means it is more likely that a man has prostate cancer.
Digital rectal exam (DRE). In this exam, the healthcare provider inserts a lubricated, gloved finger into the rectum to feel the prostate for abnormal areas. This test is not always done as part of prostate cancer screening.
Abnormal results on these screening tests can mean that a man may have prostate cancer, but these tests can’t diagnose prostate cancer. A prostate biopsy is needed to be sure. A biopsy is when small pieces of tissue are taken to be checked in a lab.
Why prostate cancer screening is controversial
Not all healthcare providers agree that prostate cancer screening is useful. This is because:
PSA test results are not always right. In some cases, the PSA test can have false-positive or false-negative results. A false positive means that test results show a man may have cancer when he doesn’t. This can lead to more tests, which can lead to stress and possible harm from the tests. A false negative means that test results don’t show cancer when a man does have cancer. This can mean you don't get the additional tests or the treatment you need.
Finding prostate cancer early may not be helpful. Even if screening does help find cancer early, prostate cancer often grows slowly and most often affects older men. This means that finding it early may not lead to a longer life. Many men with prostate cancer die years later of other causes without having symptoms or being treated for their cancer. But healthcare providers can’t always tell which cancers are likely to grow fast and need to be treated. Even if a cancer is slow-growing, a man may not be OK with living with cancer. He may want it treated. Treatment for prostate cancer can have serious side effects such as erection problems and lack of urine control.
Research in progress
It’s not yet clear if the benefits of screening for prostate cancer are greater than the possible harm. Research studies have found that prostate cancer screening can detect more cancers. But it is still not clear if screening saves enough lives to outweigh the harm treatment can cause.
Researchers are looking for better ways to tell:
Which prostate cancers need to be treated
Which prostate cancers can be safely watched instead
At this time there are no standard tests that can do this.
What expert groups recommend
Most expert medical groups agree that routine prostate cancer screening should not be done for all men. But the advice varies between groups. For example:
U.S. Preventive Services Task Force (USPSTF). The most recent draft recommendations from this group advise that men ages 55 to 69 talk with their healthcare providers about the possible benefits and harms of screening in order to make an informed decision.
American Urological Association. This group advises that men ages 55 to 69 at average risk for prostate cancer talk with their healthcare providers about being screened. Men at higher risk could have this talk earlier.
National Comprehensive Cancer Network. This group advises that men talk with their healthcare providers about the pros and cons of screening starting at age 45.
American Society of Clinical Oncology. This group advises that men expected to live at least 10 years should talk with their healthcare providers about whether or not screening is right for them.
American Cancer Society. This group advises that men talk with their healthcare providers about the pros and cons of screening. They advise having this talk starting at age 50 for those at average risk. And they advise having this talk starting at age 45 for men who are African American or who have a family history of prostate cancer.
Making a decision
All the groups advise that men talk with their healthcare providers to make an informed decision about screening. If you are thinking about being screened, talk with your healthcare provider about:
Your personal risk of prostate cancer based on your age, race, and family history
What the screening test results can and can’t tell you
What the next steps would be if the test results show you might have prostate cancer
What your options would be for treating or not treating right away
What the treatment options are if you were to have treatment, including the benefits and possible harms of different treatments
August 21, 2017
NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer Early Detection Version 2.2016. National Comprehensive Cancer Network.
Alteri, Rick, MD,Gersten, Todd, MD