Prostate Cancer Screening (PDQ®): Screening - Health Professional Information [NCI] - Evidence of Harms
Any potential benefits derived from screening asymptomatic men need to be weighed against the harms of screening and diagnostic procedures and treatments for prostate cancer.
Whatever the screening modality, the screening process itself can lead to psychological effects in men who have a prostate biopsy but do not have prostatecancer. One study of these men at 12 months after their negative biopsy who reported worrying that they may develop cancer (P < .001), showed large increases in prostate-cancer worry compared with men with a normal prostate-specific antigen (PSA) (26% vs. 6%). In the same study, biopsied men were more likely than those in the normal PSA group to have had at least one follow-up PSA test in the first year (73% vs. 42%; P < .001), more likely to have had another biopsy (15% vs. 1%; P < .001), and more likely to have visited a urologist (71% vs. 13%; P < .001).
There are no warning signs of early prostate cancer. Once a tumor causes the prostate gland to swell, or once cancer spreads beyond the prostate, the following symptoms may happen:
A frequent need to urinate, especially at night
Difficulty starting or stopping a stream of urine
A weak or interrupted urinary stream
Leaking of urine when laughing or coughing
Inability to urinate standing up
A painful or burning sensation during urination or ejaculation
Blood in urine or semen
Two cohort studies in Sweden and in the United States linked databases to examine the association between new diagnosis of prostate cancer with cardiovascular events/death or with suicide. The Swedish study found that in the first year after the diagnosis of prostate cancer, the risk of death from cardiovascular disease (CVD) was increased in men diagnosed with prostate cancer compared with men who were not diagnosed with prostate cancer (relative risk [RR] = 1.9; 95% confidence interval [CI], 1.9–2.0; adjusted for age, calendar time period, and time since diagnosis). The risk of death from CVD was highest in the first week after diagnosis (RR = 11.2; 95% CI, 10.4–12.1) and was also higher in younger men (age < 54 years). These risks were less in men diagnosed in the most recent time periods. Also in the first year after diagnosis, the risk of committing suicide was higher for men who had been diagnosed with prostate cancer (RR = 2.6; 95% CI, 2.1–3.0; adjusted for age, calendar time period, marital status, educational level, and history of psychiatric hospitalization). Again, this was highest in the first week after diagnosis (RR = 8.4; 95% CI, 1.9–22.7).
The U.S. cohort study explored the association between prostate cancer diagnosis and CVD mortality or suicide in men diagnosed with prostate cancer compared with population-level expected rates during three different time periods (pre-PSA, peri-PSA, and post-PSA). For CVD mortality, the standardized mortality ratio (SMR) was elevated for men diagnosed with prostate cancer in the first month after diagnosis in all time periods (overall SMR = 2.05; 95% CI, 1.89–2.22), but decreased in later months during the first year (decreasing to < 1.0 in the PSA time period). This association was not changed to an important degree by age, race, or tumor grade. SMRs were higher for nonmarried men, for men who lived in lower educational status or higher poverty counties, and for men with metastatic disease at diagnosis. Also, in the first 3 months after diagnosis, the SMR for suicide was higher in men with prostate cancer (SMR = 1.9; 95% CI, 1.4–2.6). In months 4 to 12, the SMR was lower but still greater than 1.0. The SMR for suicide, however, was only greater than 1.0 in the pre-PSA and peri-PSA time periods, but not in the post-PSA time period. SMR was higher for nonmarried men but did not vary by education or poverty.