The March 21 issue of the Annals of Internal Medicine has a pair of excellent articles that highlight the unresolved questions in routinely testing men for prostate cancer: Viewpoint: Limiting Prostate Cancer Screening and Viewpoint: Expanding Prostate Cancer Screening. (The abstracts of the article are available by clicking on the links, and the full text is available for subscribers.)
The confusing state of affairs is that screening for prostate cancer has still not been proven to save lives (unlike, for example, screening for colon cancer). Long term studies are currently ongoing to discover if there is a benefit to diagnosing prostate cancer early, but the results of these studies will not be available for many years. The current recommendations of the American Urological Association and the American Cancer Society is that most men be screened for prostate cancer between the ages of 50 and 75 with an annual blood test called prostate-specific antigen (PSA) and a digital rectal examination. However, the U.S. Preventive Services Task Force, the most unbiased group that evaluates the benefit of preventive testing, has decided in its most recent recommendations that there is insufficient evidence to recommend either for or against prostate cancer screening at any age.
Given these contradictory expert opinions, what should you do? First, understand that unlike preventive tests such as periodic blood pressure checks, cholesterol tests, and tests to detect colon cancer which have been proven to save lives, the benefit of testing for prostate cancer is still not solidly established. So remember that for now there is no definitive answer. Second, discuss the benefits and risks of screening with your own doctor and together arrive at a plan that is comfortable for you.
I try to practice according to the advice given at the conclusion of the first article.
While awaiting results from the major screening trials, providers should not be screening outside the existing guidelines. Rather, they should be educating their patients about the uncertain benefits and potential harms of current screening practices.
A conversation with a trusted professional is much more valuable than a controversial test.