Screening for Prostate Cancer

More men die each year of prostate cancer (an estimated 28,000 annually) than of any other cancer except lung cancer. But not every man who has this disease (about 240,000 annually) is in danger of dying of it. And sometimes the treatment can produce side effects that may be more troublesome than the cancer. For this reason, experts disagree not only about the treatment, but also about who needs screening. 

The prostate is a gland that wraps around a man's urethra, the tube that carries urine from the bladder. The prostate makes part of the fluid that carries sperm. Cancer can form inside this gland and be present for years without causing symptoms. 

If you are a man, you are at risk for prostate cancer. The risk for prostate cancer increases with age. Your risk is also higher if you are African American or have a family history of prostate cancer. 

The American Cancer Society recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of this screening. Men should not be screened unless they have received this information. The discussion about screening should take place at age 50 for men who are at average risk for prostate cancer and are expected to live at least 10 more years. This discussion should occur at age 45 for men at high risk of developing prostate cancer—African-American men and men who have a first-degree relative diagnosed with prostate cancer before age 65. It should take place at age 40 for men at even higher risk—those with several first-degree relatives who had prostate cancer at an early age. First-degree relatives include fathers, brothers, and sons.

Some other expert groups have similar recommendations, while still others have different recommendations. For example, the U.S. Preventive Services Task Force now recommends against routine prostate cancer screening because the task force believes the benefit does not outweigh the harm. 

Screening can lead to unnecessary treatment in some men. However, in most cases, the first sign of prostate cancer is that of advanced disease, such as bone pain, because of the spread of the cancer (metastasis). Inability to urinate, difficulty starting or stopping the urine flow, weak or interrupted flow of urine, and blood in urine or semen are other symptoms that could be caused by many conditions, including prostate cancer. Screening with a digital rectal exam (DRE) and a prostate-specific antigen (PSA) blood test has led to earlier diagnosis of prostate cancer, but it's not clear if this reduces the number of men dying from the disease.

What most experts agree on

Some men who have prostate cancer have no symptoms. Most experts agree that you should get tested if you have any of these symptoms:

• You urinate often, especially at night.

• You have trouble urinating or trouble starting or holding back urination.

• You have a weak or interrupted urine flow.

• You are over age 50 and often have pain or stiffness in your lower back, hips, or thighs.

Many of these symptoms can also be caused by an enlarged prostate, which has nothing to do with cancer. An enlarged prostate is common in nearly all men as they age, and it can be treated. Call your doctor if you think you may have this problem. 

How cancer is found

Doctors use two tests to look for prostate cancer: a DRE and a PSA. With a DRE, the doctor can feel whether the prostate is enlarged and whether it has unusual growths. A PSA checks for increased levels of a protein in the blood. These two tests are not always accurate. They might suggest cancer when there is none or find very slow-growing cancer, or they might not detect a cancer that is there. If either test suggests that you may have cancer, your doctor will ask for more tests to confirm this.

What should you do?

Talk with your doctor. Ask for your doctor's advice. If your doctor suggests regular screenings, ask why. And if your doctor tells you that you have cancer, explore your options. Prostate cancer can grow quickly or it can grow slowly. In some cases it can take 10 to 15 years before it poses a threat to a man's health. Prognosis depends on the extent and aggressiveness of the cancer. Very early disease in older men may be watched carefully. However, data indicate that younger men with advanced disease who are treated live longer. Ask questions. Before you make any treatment decisions, understand the advantages and the risks.