The importance of a simple prostate screening

According to the American Cancer Society, prostate cancer will be diagnosed in approximately 160,000 patients this year and is the most common form of cancer in men in the United States after nonmelanoma skin cancers. 

It is the third most common cause of cancer related-death, after lung cancer and colorectal cancer, with around 28,000 men predicted to die in 2012 in the U.S. from the disease.

“For men in the U.S., the overall estimated lifetime risk of being diagnosed with prostate cancer is approximately one in seven, with risk of death approximately one in 39,” said Bryan Wong, Dr. Bryan Wong, a board certified medical oncologist at Banner MD Anderson Cancer Center.

With these sobering statistics in mind, Wong answered several questions about prostate screening exams:

Question: Why are prostate exams important?

Answer: The idea behind screening is to identify patients so that we may intervene early and reduce morbidity and mortality from this disease. Outcome correlates with a variety of factors, especially with the extent of disease at the time of diagnosis.

Question: What does the procedure entail?  About how long does it take, and is it painful?  

Answer: Screening for prostate cancer may involve one or more tests, possibly including a blood test for prostate specific antigen (PSA) and digital rectal examination. The PSA test is a blood test drawn by taking a blood sample from a vein, and the digital rectal examination is performed in a physician’s office to feel for abnormalities of the prostate.  

Patients may experience some pressure and a sensation of urgency to urinate. There may be some discomfort if the prostate gland is irritated or swollen, or if there are nearby fissures or sores.  There may be a small risk of bleeding, for example, if there are hemorrhoids.

Question: Does everyone need to undergo screening?

Answer: There is still controversy about whether screening is warranted, as debate remains as to how much benefit is derived from screening populations, as well as recognizing issues including potential for overdiagnosis, complications of treatment, and impact on quality of life. Different groups such as the American Urologic Association (AUA), American Cancer Society (ACS), and United States Preventive Services Task Force (USPSTF) may have differing opinions. The decision to screen for prostate cancer should involve a discussion between the patient and health care provider regarding the benefits and risks of screening.

Question: When should men start getting prostate exams?  

Answer: When the decision is made to screen, recommendations for timing may vary between groups.  For example, the ACS suggests screening to begin at age 50 in patients with life expectancy felt to be more than 10 years. For patients felt to be at higher risk, such as African Americans, patients with a family history of prostate cancer, and the presence of some genetic predispositions, consideration may be given to screen perhaps five to ten years earlier.