Prostate screening can lead to problematic decisions

<p>Should all men be screened for prostate cancer, just like all women should be screened for cervical cancer? The answer to this question is not as easy or as clear as you may think.</p><p>Prostate cancer is the most common type of cancer found in American men, second only to skin cancer. It is also the second most common cause of cancer death among men, second only to lung cancer. Although men of any age can get prostate cancer, it is found most often in men over the age of 50. The risk is higher for African-American men, those whose brother, father or son had prostate cancer, men who are obese, and those who eat a high-fat diet.</p><p>With stats like this, if screening and treatment carried no significant risk, the recommendation would be clear. But the anatomy of the prostate gland makes it a unique medical challenge.</p><p>The prostate is a small gland about the size of a walnut, sitting below the bladder and in front of the rectum. Its function is to produce some of the fluid found in semen. The urethra, a tube that carries urine and semen out of the body, runs directly through the middle of the gland. Nerves that control erectile function run alongside, directly attached to the gland walls. Because of this anatomy, treatment of prostate cancer can cause erectile dysfunction, urinary incontinence, bowel dysfunction and even death.</p><p>Recently updated guidelines on screening from the U.S. Preventive Services Task Force are surprising: “There is convincing evidence that treatment for prostate cancer detected by screening causes moderate to substantial harms ... harms that are especially important because some men with prostate cancer who are treated would not have developed symptoms related to cancer during their lifetime.” The task force goes on to say, “In men 75 years and older, there is moderate certainty that the harms of screening for prostate cancer outweigh the benefits.”</p><p>Prostate cancer screening is done in two ways: the digital rectal examination (DRE), and the PSA blood test.</p><p>The DRE allows your physician to palpate the prostate gland and feel for abnormal masses. This is easily performed as part of a regular physical exam.</p><p>The PSA test is more sensitive than the DRE. Any level above 4.0 ng/ml is suspicious and warrants some follow-up care. There are other possible, benign causes of an elevated PSA. These must be taken into account when levels are elevated, so sometimes just repeating the blood test is the first response to an abnormal result. The test itself is a simple venous blood draw, but the risk comes when you must decide what to do with a persistently elevated value.</p><p>Consider which of these two men you identify with the most:</p><p>“Look, I feel good right now, and unless you are sure you are going to give me more benefit than harm, just let me be.” Or, “Cancer scares me, and if I have cancer I want to know and do something about it. I fully understand and accept the risks of treatment.”</p><p>Simplified, if finding cancer and treating it, no matter what the risks, is most important to you, you should be screened for prostate cancer. If “First, do no harm” is your priority, you should not be screened.</p><p>There is currently no scientific evidence to predict an individual’s prognosis when diagnosed with prostate cancer. For some men, detection and treatment can prolong their lives.</p><p>For others, finding this cancer can cause problems from unnecessary treatment of a disease that may never have become symptomatic at all. Because we cannot yet give definitive guidelines on screening, there needs to be clear communication between you and your physician before you make your decision. Learn the facts and decide what is most important to you. Be aware that screening may open a door to problematic decisions, so make sure you walk through that door fully informed.</p><p>A helpful source of information is prostatecancerfoundation.org.</p><p><em>Dr. Stacey Kerr, a longtime Sonoma County family physician, graduated from UC Davis Medical School and is certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hands-on medical advice or treatment. Consult your health care provider before adhering to any recommendations in this column. Email comments to drkerr@the-doctors-inn.com.</em></p>