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Screening for prostate cancer
Sunday 1st August 2010
Is screening for prostate cancer – a smart move?
Are you the kind of guy who plays it safe? Do you maintain a healthy diet, get regular exercise and refrain from smoking? If you do care about your health, you might also have considered getting a prostate check. When detected early, the risks of getting aggressive prostate cancer significantly declines and research shows patients do have a good chance of cure!
Read this brochure carefully and consult your urologist to learn more about the pros and cons of early prostate cancer detection or ‘screening.’ By doing so you don’t only play it safe, but can also make a smart move!
Some facts you might not have heard before
If you think all cancers are the same, you are wrong! Every type of cancer travels on its own path. While some seem to move at the speed of light, others are just wandering about. Usually, prostate cancer takes it very easy. Often it grows so slowly that it is not even discovered during a man’s lifetime. Prostate cancer cells seem to develop quite early in life. By the time you are 40, you have a 30% chance that your prostate may harbour cancer cells. By age 60, the chances are roughly 50%. Should you be worried? Not necessarily.
In many men cancer cells will not continue to develop into a harmful disease. Moreover, your lifetime risk of dying from prostate cancer is only about 3%. On the other hand, are you willing to take a chance? This is where screening plays a role. Wouldn’t it be smarter to detect in time and reduce your prostate cancer risk before it even gives you any symptoms?
PSA
Since the beginning of the 1990’s there has been a fierce debate about whether a simple blood test could be the answer. Prostate specific antigen (PSA) is necessary for the functioning of your prostate and a small amount constantly leaks from prostate tissue into the bloodstream.
When you have prostate cancer, in general, the leak is bigger and the PSA value in a blood sample will be higher. Unfortunately this is not always the case. Furthermore, not only cancer has influence on the PSA value in your blood. Benign prostate enlargement, urinary tract infections and even the mountain bike trip you took yesterday can interfere with PSA levels.
In other words, PSA is not very precise in predicting prostate cancer. However, if any suspicion arises, you can have more tests to see whether there is something wrong.
Pros and cons of screening
The pros are simple: screening for prostate cancer might save your life! This seems obvious but in fact, it isn’t. To come to this conclusion, 18 years of research and 162,000 men from all over Europe were involved in the study. All were followed over a mean period of nine years after entering the study called the European Randomised Study of Screening for Prostate Cancer (ERSPC). Half of them were screened with the PSA test, the other half was only followed up. In men aged 55 to 69 years, screening reduces death from prostate cancer by 20%. These findings may change in the future as more research is still being done within the ERSPC study.
The cons are less easy to understand: screening for prostate cancer could be harmful.
Confused? Take a moment to go back to the top of this brochure and read the third paragraph again.
The key message is that prostate cancer very often means no harm for its bearer. With screening, many cancers are unnecessarily detected and unnecessarily treated. Treatment for prostate cancer is a trade-off. The price for cure might among others include erectile dysfunction and urinary leakage. Over detection leads to overtreatment which ultimately leads to unnecessary side-effects and loss in quality of life.
Let’s look again at the ERSPC study: to save one man from prostate cancer death, 1,410 men need to be screened and 48 men need to be treated. So why not only treat the one guy who needs it and let the others be left untreated? Because at this point we still don’t know who he is! One of the tasks of urologists and researchers for the future is to find new markers which can help with that decision.
PSA at the age of 40 – a smart move?
It might be a smart move to get your PSA tested when you are 40. At this age, prostate cancer is a rare disease. Monitoring your PSA development over the next years or decades may help with the detection and the decision for or against treatment. In the years to come there will be more and more individualised counselling on preventive measures for risk groups to prevent unnecessary sacrifices in well-being caused by unwarranted treatment.
PSA at the age of 50 to 70 – a smart move?
If you are otherwise healthy and are willing to take the risk of overtreatment, screening is a smart move as you might benefit from it. But before you consult your doctor for a PSA test, be prepared for uncertain results. Quite often, no cancer is diagnosed even though the PSA test arouses suspicion. Be also prepared with your doctor advising you not to be treated but instead followed-up or ‘monitored’ since you might have a harmless cancer.
PSA at the age beyond 70 – a smart move?
The older you get, the less smart it is to choose for prostate cancer screening. At this age, many men already suffer from serious illnesses such as heart disease, chronic obstructive lung disease, diabetes, etc. Many of these diseases are much more serious than prostate cancer and a screening might only do more harm than good..
In general the best approach is probably to read evidence-based, balanced information on the pros and cons of prostate cancer screening. After careful consideration and discussion with your GP or urologist, you can then make a decision whether you wish to be screened for prostate cancer. If you want to learn more, in-depth and related information can be found in the websites of the EAU (www.uroweb.org, www.urologyweek.org) and the ERSPC (www.erspc.org)
