American men suffer dreadful health consequences from what many call the “silent epidemic”—prostate cancer. Prostate cancer is the second leading cause of cancer death in men. For men, it’s estimated that one in eight will be diagnosed with this disease in their lifetime. Moreover, one in 44 men will die from the disease. These sobering statistics underscore the critical need for better screening tools. For one, the prostate-specific antigen (PSA) test, despite its flaws, is still very much needed.
As of 2023, about 38% of men 50-64 years old participated in prostate cancer screenings. However, experts are urging men between the ages of 50 and 70 to be aggressive. They need to have an annual discussion about the risks and benefits of PSA testing with their healthcare provider. African American men and men with a family history of prostate cancer are at a greater risk of developing this disease. Furthermore, people carrying germline mutations such as BRCA1 or BRCA2 are even more susceptible.
The PSA test remains an important technology in the early detection of prostate cancer. It’s not without its challenges. The test is expected to lead to false positives in 6-7% of cases in each screening round. Furthermore, some 15% of people who receive normal PSA test results actually do have prostate cancer.
“There are risks to the test,” – Dr Nancy L Keating, MD, MPH
In spite of these dangers, many medical professionals continue to stress the need for early detection. We cannot overstate the benefits of catching prostate cancer early. Prostate cancer, if untreated, can metastasize to other body parts, significantly decreasing the five-year relative survival rate to just 37%.
More recent estimates suggest that 20-40% of screen-detected prostate cancers would not cause harm if left untreated. This begs the question of whether broad screening practices are even warranted.
“The small reduction in prostate cancer deaths by using the test to screen healthy men does not outweigh the potential harms,” – Professor Richard Martin
Prostate cancer treatments such as surgery and radiation therapy can cause severe side effects. These range from incontinence to sexual dysfunction. This highlights the critical need for men to weigh the potential benefits against the risks associated with screening and subsequent treatments.
“But most prostate cancers are not likely to be deadly, and many men will experience the harms of screening, such as anxiety and unnecessary biopsies, and treatments like radiation or removal of the prostate that can lead to incontinence and erectile dysfunction, without experiencing benefits,” – Dr Nancy L Keating, MD, MPH
Healthcare providers are put into a very difficult position when counseling patients on what screening protocol to follow. As a result, most men will be asymptomatic until their disease is at an advanced stage, underscoring the importance of timely testing. Dr Clifford Gluck emphasizes this necessity:
“Many men with prostate cancer won’t experience any outward signs or symptoms until the disease is advanced, which is why testing is so critical.”
The current and very vocal debate over prostate cancer screening highlights just how complicated the provision of care has become. Some public health officials argue for the necessity of screening as it allows for early treatment or prevention of diseases. Critics say it can’t be used too liberally, given the dangers of false positives and subsequent overtreatment.
“This results in some men going on to have invasive treatment that they don’t need, many years earlier than without screening, and the test is also failing to spot some cancers that do need to be treated,” – Professor Richard Martin
Dr. Nancy L. Keating acknowledges that screening provides limited benefits for targeted populations. She advocates for patients to have more informed, guided discussions with their physicians.
“But that patients should make an individual decision about screening after discussing potential benefits and harms with their doctor,” – Dr Nancy L Keating, MD, MPH