We've been hearing it for decades - the earlier a cancer can be found, the better the chances for successful treatment and a cure. That's an absolute truth, right? Turns out, it's not so cut and dried.
A great example is the current controversy surrounding routine prostate cancer screening. A prostate cancer screening consists of a blood test to look for a substance called PSA (prostate-specific antigen) and a digital rectal exam.
For years, the American Cancer Society and the American Urological Association agreed that routine screening for prostate cancer should be part of a man's annual health exam, beginning at age 50 for Caucasians and at age 45 for African American men and those with a family history of prostate cancer in either a father or a brother.
Then, in 2011, the U.S. Preventive Services Task Force came out with recommendations AGAINST routine prostate screening. This independent panel of experts reviewed the data collected from prostate screening trials and found that the "harms of PSA testing outweigh the benefits." How could that be?
- A prostate cancer screening cannot determine which cancers are aggressive and need treatment, and which cancers will grow so slowly that treatment can be avoided. Treatment can be difficult, and the potential for side effects include urinary incontinence, bowel dysfunction and impotence all of which can greatly affect a person's quality of life.
- The PSA test often results in false positives that lead to great anxiety, more tests, more expense - and more biopsies, which themselves present risks.
- For those gentlemen who are diagnosed at an early stage, a doctor may recommend "active surveillance," meaning no treatment right away, with regular tests conducted to see if cancer progresses. Some men feel this is not aggressive enough and opt for treatment, which has its own side effects and risks.
- The main goal of screening is to reduce deaths. The task force found that over 14 years, screening prevented only a very small number of men from dying of prostate cancer. Thus, the panel's recommendation is based on statistical probability.
So what's a man to do? While there is still disagreement from the experts, all believe it is important for men to have a discussion with their family doctor on the benefits and risks of prostate screening. Then, based on any symptoms or family history, the doctor can make a recommendation more suited to the individual.