Why can't doctors make up their minds about a test that screens for prostate cancer? Just five years ago - in 2012 - the American Cancer Society discouraged men from regularly getting a PSA blood test to screen for the disease, saying it was of questionable value. Now, the U.S. Preventative Services task Force is telling men the screening could save their lives. Why the differing opinions? A lot of it has to do with the very nature of prostate cancer.
"Prostate cancer is a slow growing cancer and in many cases never spreads outside of the gland," says Blake Hamilton, MD, a urologist with University of Utah Health. "What's happened over the last couple of decades is when men are diagnosed with prostate cancer based on PSA screening they automatically have gotten treatment. So, in a sense, as a community we've over-treated men with prostate cancer."
It is that overtreatment that has led to some recommending that men without a familial history of prostate cancer skip the screening. After all, some of the treatments can lead to incontinence or impotence, and all come with some degree of discomfort and financial burden. In men where the disease is not going to progress, these outcomes are worse than simply leaving the disease alone.
"According to the American Cancer Society, 161,000 men will be diagnosed with prostate cancer this year in the United States. Some 26,000 men will die from prostate cancer," says Hamilton. "To say that prostate cancer screening with PSA has come and gone would be throwing the baby out with the bathwater."
"What we need to do is keep the screening but make better decisions about when to biopsy and when to treat prostate cancer," says Hamilton. "I think most urologists have the ability to evaluate an elevated PSA and make a decision on a biopsy. If you have a single elevation in the PSA, it's reasonable to wait some time and repeat it and think about what that means."
There is also some consensus about when PSA screening is not necessary. For example, screening is not routinely recommended in men over the age of 70 - or in men younger than 55. "The American Urological Association has modified their guidelines to suggest that we screen maybe not every year but every two years in men between the ages of 55 and 70 where we think that we'll find the highest yield of prostate cancer in the patients for whom it will really matter," says Hamilton.
In the end what it all comes down to is the individual patient and their doctor. "If a man is concerned about prostate cancer he should discuss the possibility of a P.S.A. test with his physician and ask about the differing recommendations out there," says Hamilton.