In recent years, official guidelines have shifted away from routine screening tests for this disease. But some health experts say that each man -- with advice from his doctor -- should answer the question for himself.
In 2012, the U.S. Preventive Services Task Force recommended against blood tests that check for prostate cancer, because the evidence didn't support the practice. Recent studies have since begun to tally the effects of those recommendations. Two of them found that the number of prostate cancer diagnoses dropped along with the dip in the number of screening tests.
"If this decline is because men are making informed choices, then I think that is a good thing," says Otis Brawley, MD, chief medical officer for the American Cancer Society and co-researcher on a study marking the drop in prostate cancer diagnoses.
Screening involves a PSA test, which measures proteins called "prostate-specific antigens" in the bloodstream. Levels above a certain threshold may lead to more testing.
Doctors don’t yet know whether the drop in screening test rates will result in a drop -- or an increase -- in prostate cancer deaths, but it is clear, Brawley says, that screening tests can be harmful.
"We have good data to show that the aggressive screening done back in the 1990s and early 2000s led to the diagnosis and treatment of over 1.1 million men who, if they had never been tested, never been diagnosed, never been treated, were destined never to be bothered by their prostate cancer," he says.
Brawley says prostate surgery leads to impotence in as many as 40% of patients and incontinence in an equal number. Some have both.
So, should all men avoid prostate cancer screening tests? No, Brawley says. "I am for informed decision-making. I will admit it may save lives, but I would like to tailor screening to men who are at higher risk and men who are very concerned about prostate cancer."
The American Cancer Society recommends most men talk to their doctor about the disease around age 50. Men who have a higher risk, including African-Americans and those with a family history of this cancer, should have that conversation at 45. If more than one close relative has had prostate cancer, talk to your doctor at 40.
Here are some questions to ask at your next appointment:
1. Am I at higher-than-normal risk for prostate cancer?
2. Would I benefit from getting a screening test for it?
3. What risks do I face if I decide to be tested?
4. If cancer is found, should I be treated? What will determine that?
5. When is "watchful waiting" a better option than treatment? And what does that involve?
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