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Prostate Cancer Controversy: Should You Get Screened?

Headlines warn prostate cancers have spiked by 72%—here’s the breakdown on the numbers and what they may mean for you.

You might have seen the headlines: metastatic, or late-stage prostate cancer diagnoses have increased by 72 percent over the past decade. But before you panic, let’s take a closer look at the controversy surrounding this study.

Researchers from Northwestern University reviewed more than 700,000 cases of prostate cancer between 2004 and 2013. The results were alarming—prostate cancer screenings declined and the number of metastatic cancers “skyrocketed.” The findings, which were published in Prostate Cancer and Prostatic Diseases, received mixed reactions.

“The number of late-stage diagnoses is particularly bothersome—unlike localized prostate cancer, metastatic prostate cancer is not curable. We’re only able to treat its symptoms and often times patients die from it,” says Sherwin Zargaroff, MD a urologist specializing in prostate cancer at Plantation General Hospital in Plantation, Florida.

The greatest number of new cases was found among men ages 55 to 69, who experienced a 92 percent uptick in diagnoses. “That's deeply troubling as well because this age group is the most likely to benefit from prostate cancer screening and early treatment,” adds Dr. Zargaroff.

Do fewer screenings really mean more cancer cases?
The lack of prostate cancer screenings might have played a part in the increase, researchers reported.

In 2012, the United States Preventive Services Task Force (USPSTF) recommended against testing men’s blood for prostate-specific antigen (PSA) during routine screenings. PSA is a protein that’s produced by the prostate and tends to be higher among those with prostate cancer. Screenings often include both a PSA blood test and a rectal exam to check for tumors.

By discouraging the PSA test, the task force might have played a role in the study’s outcome. Although, the authors acknowledge that the numbers began rising before the USPSTF made its recommendation.

In April 2017, the task force revealed their new tentative position on the PSA, which stated that men between the ages of 55 and 69 should make an informed decision with their doctor about whether the test is right for them. The group still advises against screening for men over 70 and gives no recommendation for those under 55. 

Between April 11 to May 8, 2017, you can comment on the task force’s draft statement at www.screeningforprostatecancer.org. After reviewing and considering any feedback, the USPSTF will publish its official stance.

Mixed responses to the study   
Another reason for the spotlight is disagreement among experts over the approach that researchers used in their data analysis.

“The way epidemiologists measure things like incidence and mortality is to study rates, the number of cases per a number of people (usually per 100,000) to look for trends. But this study, done by a group of urologists, didn’t do that. Rather than measure rates of metastatic disease, they looked at the number of cases. That is far from the same thing,” says Otis Brawley, MD Chief Medical Officer of the American Cancer Society (ACS) in a statement issued by the ACS Press Room.

Other trends like the rapidly growing population of older adults can make the raw numbers less reliable, Dr. Brawley explains. If there are more older men, there will probably be more cases of prostate cancer. The trends could also be due to more aggressive cancers.

However, the American Cancer Society continues to stress that men should learn about the risks and benefits of prostate screenings so they might make an informed decision about whether screening is right for them.  

Risks of prostate cancer screening
The most significant risk of PSA screening is receiving cancer treatment that you don’t really need. This could happen if your screening comes back with a false positive or if you have a prostate cancer that’s small or slow-growing— even if left untreated, many prostate cancers never become life threatening.

If you receive unnecessary cancer treatment, you could experience side effects including impotence, difficulties urinating and incontinence.

It’s also possible to receive a false negative, which may cause symptoms to get shrugged off, leading to late treatment. 

Benefits of prostate cancer screening
Getting tested for prostate cancer could save your life if it successfully detects early-stage cancer. The earlier cancer is found, the sooner treatment can be started. It also simply may bring you peace of mind. Alternatively, being diagnosed with a harmless cancer can cause a great deal of anxiety, which is why you should have thoughtful discussions with your doctor before making a decision about screening. 

Many urologists shared the USPSTF’s initial concern over treating fairly non-aggressive prostate cancers, so the urology community has been working to improve tests for diagnosis, says Dr. Zargaroff.

“New genetic studies are able to test the urine and the blood and can tell us how aggressive the prostate cancer likely will be. We’ve also implemented active surveillance programs where we closely watch patients with seemingly unaggressive cancer rather than putting them into a full-blown treatment program,” he explains.

When to talk to your doctor about prostate cancer screening
Ask your doctor about your risk for prostate cancer and discuss whether a screening is right for you beginning at:

  • Age 40 if you have more than one immediate family member (father, son or brother) who developed prostate cancer before age 65
  • Age 45 if you’re African American or if you have one immediate family member who was diagnosed with prostate cancer before age 65
  • Age 50 if you’re at an average risk of prostate cancer

“I would just caution men who are interested in having a PSA test done not to assume their doctors are automatically ordering it for them,” says Dr. Zargaroff. “A lot of insurers might not be covering the screening protocol right now, so they should tell their doctor if they’d like to be tested.”

Educate yourself about the risks and benefits of prostate cancer screening and work with your doctor to decide when you should start and how often you should have screenings done.  

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