Are There Any Arguments Against Screening For Prostate Cancer?

Dr. Brawley answers the question: 'Reasons To Not Test For Prostate Cancer?'

March 16, 2009 -- Question: Are there any arguments against screening for prostate cancer?

Answer: Screening for prostate cancer is controversial. Most medical professional organizations actually recommend that men be informed that the test exists, be offered the test, and be encouraged to make a decision as to whether they should get the test.

There are potential risks and there are potential benefits to prostate cancer screening - let me explain that a little better.

One of the problems with prostate cancer screening is we know for fact that prostate cancer screening identifies a group of men who while they have cancer, they have a cancer is that is of no threat to their health.

Prostate cancer screening ends up causing a large number of men to get treatments that they don't need. Perhaps as many as half of all men who are diagnosed with localized prostate cancer, actually would benefit from being observed versus than being treated.

We don't know or don't have a test that can tell us 'Mr. Jones you have a prostate cancer that needs to be treated because it's a threat to your life.' 'Mr. Smith you have a prostate cancer that needs to be watched because we don't think it's a threat to your life.'

In addition, there are a group of men, perhaps a third of all prostate cancer patients who are identified who have normal PSA and normal digital rectal exam.

So the test finds disease that doesn't need to be treated. The test misses a lot of disease that does need to be treated. The end result is we don't have a clinical study yet to tell us that the population which is screened has less prostate cancer deaths versus a population that is not screened. We do have studies to show that a population that is screened has more prostate cancer treatment.

Prostate cancer treatment has a number of side effects, including impotence, incontinence, men who have difficulty urinating as well as men who wet themselves a lot.

The end result is we don't know if prostate cancer screening is beneficial. We're all committed to do the clinical trials and hopefully in the next several years will have a define answer 'does prostate cancer screening save lives?'