Prostate cancer is the most common cancer among men, except for skin cancer that is generally not as serious except for melanoma. This year, an estimated 164,690 men in the United States will be diagnosed with prostate cancer. Understanding how to best detect prostate cancer is the first step to helping.
In the past, a prostate-specific-antigen (PSA) blood test and rectal exam were recommended for men over the age of 50. Those men with a higher risk such as having a positive family history or being African American should begin screening at a younger age such as 45.
PSA is a protein produced by cells in the prostate gland. Normally levels are low in the blood but anything from benign inflammation or enlargement to serious cancer can cause the PSA to be elevated. Levels also rise normally with age so that a seventy-year-old man’s normal level is higher than it was when he was age fifty. The rate of change can be meaningful to a urologist looking for a changing or worsening condition.
In the United States, most men over the age of 50 years have had a PSA test. According to two New England Journal of Medicine (NEJM) articles and an accompanying editorial, the problem of over diagnosing and over treatment, which can cause other complications, may be significant.
The controversy about screening is based on a study by the U. S. Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trail. This eleven-year study included 80,000 American men; it showed no change in the number of deaths from prostate cancer among those who were regularly screened with the blood test and rectal exam. In the same issue of the NEJM, another article with a study involving 182,000 European men found a 20% lowering of prostate cancer deaths.
One important note is that the PSA test was introduced in 1992 and since then the death rate from prostate cancer has fallen about 4% per year starting about five years after the introduction of the test. 95% of male urologists and 78% of male primary care physicians who are over the age 50 have had a PSA. So, physicians themselves believe in early detection.
Overall, no test is perfect and more information is still pending concerning screening for prostate cancer. Prudent men should consult with their physicians to understand the benefits of early detection, as well as the modest limitations of prostate cancer detection. Being informed and diligent is always smart. There are many effective and relatively safe treatments for prostate cancer, making early detection even more worthwhile.
The more one knows about any illness or condition, the better one can take care of oneself. Prostate cancer is a perfect example of an illness which can be largely cured by early detection. Let’s use this education to help the men among us.