By Dr. Moss Linder, Grace Cottage Family Health
Sometimes, a doctor can give medical advice that fits everyone, things like stop smoking, get regular exercise, and eat a healthy diet. Other times, a medical issue can’t be decided with a one-size-fits-all approach. Prostate cancer screening recommendations are one of those topics.
The prostate is a gland in a man’s body that surrounds the urethra, the tube through which urine flows. Prostate cancer is a disease that causes the gland to grow abnormally. Most prostate cancers have no symptoms at all, and the cancer grows so slowly that it does not cause any major problems. Some men may have urinary frequency or urgency or waking up at night to urinate.
The most common risk factors are age (more than 80% of prostate cancers are detected in men 65 or older, according to the American Society of Clinical Oncology); ethnicity (prostate cancer is more common in African-American men); and a family history of prostate cancer. There is research that a high fat diet may also contribute to the risk.
Prostate cancer is the most common solid organ cancer in men and, behind lung cancer, the second leading cause of cancer death.
There are two basic tests for prostate cancer screening. One is a prostate specific antigen (PSA) blood test that looks for a particular substance in the blood that may indicate the presence of prostate cancer. Other conditions aside from prostate cancer can also cause this test to be elevated. The other test is a rectal exam to see if the prostate is abnormal–uncomfortable, but useful for diagnosis. This test also can have drawbacks in that an abnormality can be missed or an abnormal exam may not be indicative of prostate cancer.
So, who gets screened for prostate cancer?
In the past, medical experts recommended that men over the age of 50 or 55 be screened for prostate cancer every year. Now, the advice is, it depends. As medical knowledge has evolved, the most recent research suggests that for most men, annual screenings may not be warranted.
The reason for this is that most men who develop prostate cancer will actually die for some other reason, such as heart disease or stroke. In fact, autopsy studies have shown that over 70% of men in their 70’s have evidence for prostate cancer. The side effects of treatment can have a profound effect on quality of life. They can include urinary incontinence, erectile dysfunction, bowel issues and osteoporosis, among others. Also the testing, PSA’s and rectal exams, can either over-diagnose or under-diagnose this condition.
On the other hand, since the introduction of PSA as a screening tool in 1986, the number of total prostate cancer deaths has decreased by approximately 30%. Early detection and treatment has decreased the number of patients suffering from possible consequences of advanced prostate cancer, such as severe bone pain and big tumors that obstruct the urinary tract.
To make matters even more confusing, there are differing and conflicting recommendations from major medical societies.
In summary, prostate cancer screening issues are nuanced. It is not an easy decision to make. A good approach to this issue is to discuss it with your provider at an annual wellness exam with thoughtful, shared decision making.
Dr. Moss Linder joined the Grace Cottage Hospital staff in 1997. He received his medical degree from the University of Vermont in 1991 and completed his Family Medicine residency at Oregon Health Services University. Prior to Grace Cottage, he worked as a family physician at the Acoma Cañoncito Laguna Hospital in New Mexico.
