May 29, 2002 -- As doctors become better at finding prostate cancer, younger men are being told they have this potentially deadly disease. While this allows earlier treatment, some question whether this is a good thing.
From 1995 to 2001, the number of men aged 50 to 59 being diagnosed with prostate cancer jumped by 45%. Researchers presented their dramatic findings at a meeting of prostate cancer specialists.
That does not mean a new epidemic is upon us. Thanks to better awareness of prostate cancer and the use of PSA blood testing, doctors are finding more tumors, and they are finding them earlier.
PSA stands for "prostate-specific antigen," a protein produced by the prostate gland that circulates in the blood. If a blood test shows high PSA levels, it could mean that a tumor is growing in the prostate -- but not necessarily.
A high PSA level often leads to a prostate biopsy, which has led to an increase in the number of cancers detected.
PSA testing is controversial, however. While a high PSA level may indicate prostate cancer, it might also just mean that a man has an enlarged prostate -- a common, and benign, finding in aging men.
Many doctors check PSA levels in men starting at age 50 -- or earlier in men at high risk, such as blacks or men with a family history of prostate cancer. But some experts don't think all men over 50 should be screened. Prostate cancer grows so slowly that men often die "with it, not of it," so it's possible that early detection may not lead to fewer deaths.
Studies are being done now to find out whether that's true, but they will take a long time to complete. According to urologist Myron Murdock, MD, even results from a 10-year study might not give us the answers that we need. Again, that's because prostate cancer can grow for so long before it becomes deadly.
Lacking a clear answer, a better-safe-than-sorry policy seems to make sense. "They used to have arguments like this about Pap smears," says William Catalona, MD, professor of urology at Washington University in St. Louis. Now, women are told to get them yearly to check for abnormalities of the cervix that could become cancerous.
Nevertheless, "A consequence of screening is that you're going to overtreat the disease," says Gerald Chodak, MD, of the University of Chicago. "We run the risk of doing a lot of harm to people."
Prostate cancer treatment -- surgical removal of the prostate or radiation therapy -- can leave a man impotent or incontinent. If you're 50 years old and in otherwise good health, you might spend the next two decades dealing with those consequences. A less compelling argument to patients, but a dear one to the healthcare industry, is that screening and treatment cost a lot of money, which may turn out to be wasted if deaths are not prevented in the long run.
"I would rather be in this position than the other," says Paul Lange, MD, of the University of Washington in Seattle. He says he's in favor of screening because he would feel awful if he didn't screen his patients, should doing so eventually be proven to save lives.
Another study presented this week suggests that it's good to screen. Researchers in the Netherlands compared the number of cancers found in men who took part in a screening program with the number found in men who saw a doctor only after developing prostate cancer symptoms. They looked at the cases of more than 35,000 men aged 55 to 74 and found that screening detected 818 cancers, whereas only 150 were diagnosed without screening.
In addition, among the men who were not regularly checked, close to 7% had cancer that had spread beyond the prostate gland -- compared with less than 1% of those who had been screened.
But even if regular prostate checkups are warranted, maybe they're being done too often. "When we began screening for prostate cancer we did it every year," says E. David Crawford, MD, of the University of Colorado. "We didn't know any better."
Crawford presented a study this week that looked at the time it took for men's PSA levels to rise into the danger zone. A PSA level of less than four is considered normal. When it goes over that, there may be a tumor.
Based on his study results, Crawford made a recommendation: If a man's PSA level is less than one, he should be tested once every five years. If the level is between one and two, he should be tested every two years. If PSA level is greater than two, then yearly screening is the way to go.
Only you and your doctor can decide what's right for you. Talk to your doctor to see if you're due for a prostate check-up.