Prostate Cancer Screening
The purpose of any cancer screening exam is to detect disease early to allow for more effective treatment, and hence save lives. Prostate cancer is the second leading cause of cancer death among American men. An estimated 241,000 American men are diagnosed with prostate cancer every year and 34,000 die of the disease. During his lifetime, 1 in 6 men will be diagnosed with prostate cancer and 1 in 36 will die of the disease.
Risk factors for prostate cancer include age (most prostate cancer occurs in men age 65 and older), family history of prostate cancer, and African American race. Men with a first degree relative (father or brother) who has had prostate cancer before the age of 65 are at high risk. Those with several first degree relatives with prostate cancer are at very high risk. Other risk factors may include a high fat diet and obesity.
The primary screening tests for prostate cancer are Prostate Specific Antigen (PSA) and the Digital Rectal Exam (DRE). PSA is a simple blood test that detects a protein in the blood that is usually elevated in prostate cancer. DRE is an exam in which a health care provider inserts a gloved finger into the rectum to feel the prostate for lumps or other abnormalities.
The American Cancer Society recommends that annual prostate cancer screening be considered starting at age 50 for men who are at average risk for prostate cancer and at age 45 for those at high risk. The US Preventive Services Task Force, on the other hand, does not recommend PSA screening in healthy men.
The PSA test is controversial because there is no clear evidence that screening with PSA actually saves lives. The main problem is that only 25-35% of men with elevated PSA have prostate cancer. The rest have benign conditions such as inflammation or enlargement of the prostate. This can lead to unnecessary tests and overtreatment of slow growing prostate cancer tumors that can lead to side effects.
What is a man to do with this conflicting information? The best advice is to talk to your health care provider about your individual risks and needs and decide what is best for you.
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