To Screen Or Not To Screen- That Is The Question

There is a lot of confusion about prostate cancer screening with PSA. How about a test where three out of four men with elevated PSAs are found by biopsy not to have cancer after all? A better test would be flipping a coin! Most studies on screening conclude that there is little evidence that it saves lives from prostate cancer. Men who were followed by observation (watchful waiting) faired no worse than those treated for the disease. In this study, 48 men had to be treated for prostate cancer to save one man from dying from the disease. I know what you’re thinking. Who cares as long as I don’t get cancer! However it’s not so simple. By treatment, I mean radical surgery or radiation which results in incontinence, impotence and shortening of the penis and there is a risk from dying from the treatment. Still want treatment? If we weren’t doing PSAs in the first place men wouldn’t be confronted with deciding what course to choose if they were faced with a diagnosis of cancer. So, what should men do? Every professional organization concerned with prostate cancer recommends that you discuss the pros and cons of screening. Here’s the problem with this. Most PSAs are ordered by primary care docs who know little about the controversy/recommendations. I know this first hand. When I was forty my doc did a PSA without my knowledge. I only realized it after he told me it was normal. Now what? I am now on the PSA treadmill. Screening is a personal decision to be made only after carefully examining its pros and cons. This can only be successfully done if you are well informed which means having a down to earth conversation with your doctor.


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