Prostate cancer: Should you be screened?

September 10, 2015 Providence Health Team

If you are a man headed into middle age, you may be thinking about what you can do to stay healthy.

One thing you should do is learn more about prostate cancer.

Prostate cancer is the most common cancer in men and the second-leading cause of cancer death, behind only lung cancer. The chance of having prostate cancer goes up with age, and about 17 percent of men who are now 50 will be diagnosed with prostate cancer in their life.

What the experts say

Screenings – tests to look for a disease before a person actually has any symptoms – are available for prostate cancer.  A prostate-specific antigen test checks for elevated PSA levels in your blood. A PSA blood test often is done along with a rectal exam to detect prostate cancer at an early stage.

But most experts no longer recommend routine PSA screening for two reasons:

  • Studies have shown that PSA screening has little or no effect on prostate cancer deaths.
  • PSA testing has led to overdiagnosis and overtreatment.

The uncertainties

Most prostate cancers grow slowly and don’t cause health problems in men who have them. But there also are aggressive types of prostate cancer that have the potential to kill. A screening may find one of these dangerous cancers while it is small and before it has spread. On the other hand, a screening could find a cancer that might never have caused problems or death, but the patient gets treatment he does not need.

Adding to this uncertainty, a PSA screening cannot always tell for sure if you have prostate cancer, and there is no PSA level that says for sure that prostate cancer is present.

Some guidelines

What should you do when there don’t appear to be easy answers?

Here are some general guidelines from the American Cancer Society:

  • Starting at age 50, talk to your doctor about the pros and cons of testing. Then decide if testing is the right choice for you.
  • If you are African American or have a father or brother who had prostate cancer before age 65, have this talk with your doctor starting at age 45.
  • Men with two or more close relatives who had prostate cancer before age 65 should talk with their doctors at age 40.

An informed decision

The American Cancer Society and the US Preventive Services Task Force both recommend against PSA screening for men with no symptoms.

Is screening the right choice for you? Before you decide:

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