Early Detection and Screening

Early Detection and Screening

Prostate cancer screening is controversial. On one hand, detecting prostate cancer early may allow for more treatment options with potentially fewer side effects. On the other hand, because most prostate cancers grow slowly, the side effects of treatment may outweigh any of the benefits of early detection.

Screening Tools

Because prostate cancer does not typically cause symptoms until advanced stages, two tests are currently used to detect the disease at earlier stages.

The first is the Prostate-Specific Antigen (PSA) Test. PSA is a protein produced by the prostate gland. The PSA test measures levels of PSA in blood, with a higher PSA level indicating a greater likelihood of prostate cancer.

The second test is a Digital Rectal Exam (DRE). In this exam, a doctor inserts a gloved finger into the rectum to feel for hard, lumpy, or abnormal areas on the prostate.

False-positives may occur in both of these tests. There is much evidence that PSA and DRE are best used together. As the PSA increases, the positive predictive value of the DRE also increases.

Screening Debate

Research on prostate cancer screening effectiveness reaches mixed conclusions. Two large randomized trials investigated the usefulness of screening men for prostate cancer with the PSA blood test. The first trial was conducted in the US and explored whether intensive (frequent) screening was more effective than opportunistic (in-frequent) screening at saving lives. The second trial was conducted across multiple countries in Europe and examined whether intensive screening was better than no screening at all. The US study did not find intensive screening to be better than opportunistic screening. However, it did find that intensive screening reduced prostate cancer related deaths in healthy men under age 65. Conversely, the European study found that intensive screening reduced prostate cancer mortality by 20-28%.  Importantly, the European study showed that this effect was most pronounced in Northern European countries including Sweden, Netherlands and Finland.  Norway, as a country, did not participate in the trial so we do not know the exact benefits of screening in Norway.  However, it seems logical that if screening helped save lives in all the countries surrounding Norway, that it would also be beneficial for Norwegian men.

While urologic oncologists agree that screening for prostate cancer can reduce prostate cancer mortality, it can come at the expense of over-diagnosis and over-treating men with non – life threatening cancers.

When to Start Screening

For a man at average risk of prostate cancer, PSA screening should begin at age 55 and continue annually or biennially until age 69. While these screens can reduce mortality from prostate cancer, these benefits must be weighed with risks of overtreatment.

Men at increased risk of developing prostate cancer include those with a family history (first degree relative) or those of African or Scandinavian descent. These men may want to initiate screening at age 40.

Initial PSA measurements at age 40 may help determine or identify men at higher risk of developing prostate cancer. Consult with a doctor to develop a prostate health plan based on your individual lifestyle and family history.