Prostate Screening: What Should You Do?

In the words of that great philosopher, Yogi Berra, "This is like déjà vu all over again."

Maybe yes, maybe no.

If you assume that the new guidelines for the early detection of prostate cancer released Wednesday by the American Cancer Society don't offer anything different compared to the last major revision of the guidelines in 2001, then you may be missing some important messages about prostate cancer screening.

And you may miss what I consider the most important message of all: prostate cancer is so common in men age 50 and over that finding it by prostate cancer screening may be nothing more for most men than a fortuitous "random walk." As I learned myself, even with a perfectly normal PSA there is a real possibility that you have prostate cancer. Whether you need to find it or not is the heart of the issue.

VIDEO: Cancer Society Casts More Doubt on Prostate Tests

Prostate cancer is clearly a major health issue in the United States. The American Cancer Society estimated that in 2009 (the latest year for which statistics are available) 192,280 men were diagnosed with prostate cancer, making it the most common form of cancer in men. Deaths from prostate cancer in the United States for 2009 were estimated to be 27,360, underlining the fact that many more men are diagnosed with the disease than die from it.

That's the relatively easy part of the discussion. The hard part -- as has become all too obvious to many over the past year through the controversy caused by the release of two studies that were supposed to answer the question of whether detecting prostate cancer early really made a difference in survival -- is whether prostate cancer screening really makes a difference in survival.

So controversies exist about what to do regarding the early detection of prostate cancer in men and whether getting a blood test called a prostate specific antigen (or PSA) with or without a rectal examination is something that men should do to save their lives.

Lo and behold, the evidence isn't clear on this topic, despite the fact that we have been vigorously administering PSA tests for about the past 20 years, and are busy every day in this country lopping out and radiating prostates to treat prostate cancer, leaving many of those men with serious long-term consequences like decreased sexual function and urinary incontinence.

Given all of this uncertainty and inconsistency of the evidence, you would rightly ask, "What does the American Cancer Society recommend men should do when it comes to that annual rite of a PSA blood test to find prostate cancer early?"

So here are the major recommendations from the guidelines:

Asymptomatic men who have at least a 10-year life expectancy should have an opportunity to make an informed decision with their health care provider about screening for prostate cancer after receiving information about the uncertainties, risks, and potential benefits associated with screening.

Men at average risk should receive this information beginning at age 50. Men at higher risk, including African Americans and men with a first-degree relative (father or brother) diagnosed with prostate cancer before age 65, should receive this information beginning at age 45. Men at appreciably higher risk (multiple family members diagnosed with prostate cancer before age 65) should receive this information beginning at age 40.

Men should either receive this information directly from their health care providers or be referred to reliable and culturally appropriate sources.

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