Is Prostate Cancer Screening Still Necessary?
The current test for prostate cancer continues to spark debate. In part 1 of WebMD's 2-part series, there's important prostate cancer information that men should have.
To Screen or Not
In fact, despite controversy, most doctors agree the PSA remains an
important and necessary diagnostic tool.
In addition to the ACS report, Hall adds that "there is no question that
since the PSA era the two things that have changed are fewer men are diagnosed
with metastatic cancer, and we have seen a decrease in the mortality rate from
prostate cancer overall, all because we are picking up the cancers
The question remains, however, is who needs testing the most, how often, and
when? Today, most doctors agree it's a patient-by-patient decision, with only
the most flexible guidelines to follow.
One factor that is important for all men, however, is their age. But if
you're thinking the older you are, the more you need this test -- guess
"The longer your life expectancy, the more important it is to find a
prostate cancer early -- so the more important the PSA becomes," says
Also important to consider, say experts, is a man's general health. Your
life expectancy, says Lepor, should be at least 10 years in order for the PSA
screen to be beneficial.
Hall agrees, "The average life expectancy is somewhere around 78 to 80
and most prostate cancer patients live a long time even without treatment. So
even if you did find the cancer at that age it's not likely you would do
aggressive treatment, so testing is less necessary in men over 70 or 75,"
Currently, American Cancer Society (ACS) guidelines recommend doctors offer
the PSA blood test and the DRE yearly to men aged 50 with a life expectancy of
at least 10 years. Providers should discuss with them the risks, benefits, and
limitations of testing. Men at high risk -- including blacks and all men with a
close relative who had prostate cancer before age 65 (father, brother, or son)
-- should start testing beginning at age 45.
Those men at ultra-high risk -- with several close relatives with prostate
cancer at an early age -- are recommended to begin testing at age 40.
At the same time, it's important to note that ACS cautions that no major
scientific or medical group recommends routine testing for prostate cancer at
this time. Instead, they suggest a case-by-case analysis based on each man's
Says Lepor: "The bottom line is there are no rules set in stone -- every
man needs to talk to his doctor about when to start screening and how often,
and in the event a cancer is suspected or diagnosed, they need to openly
discuss the options of biopsy and ultimately, treatment," says Lepor.
The Future of Prostate Screening
Two advances that could one day make the PSA obsolete.
In the first advance, Chinnaiyan and his team looked to the body's own
immune system for clues about prostate health.