To screen or not to screen? That’s the first question.September 22, 2017
Prostate cancer is a major men’s health issue as it affects one in seven men at some point in their lifetime. But there’s a twist – many more men die with prostate cancer than men who die because of prostate cancer. While some forms of prostate cancer are fast-moving and aggressive, others grow slowly and pose low risks to overall health and life expectancy. For these reasons, the benefits of early detection and treatment need to be weighed carefully alongside the risks of diagnosis and potential side effects of treatment.
What Men Need to Know
According to the American Cancer Society, cancer of the prostate is second only to skin cancer as the most common cancer affecting men. Prostate cancer is rare under the age of 40 and is most often diagnosed after age 65. Family history of prostate cancer increases your risk, as does race. For example, African-American men are 73 percent more likely to develop prostate cancer and more than twice as likely to die as a result.
Additionally, according to the Prostate Cancer Foundation, there are certain factors that may increase your risk for more aggressive forms of prostate cancer, including smoking, obesity, sedentary lifestyle diet that lacks vegetables especially those in broccoli family.
“All of this information is important for men to consider when they are faced with the question of whether to be screened for prostate cancer,” according to Dr. Dan Trajano, senior medical director at Blue Cross.
“It’s important for men to make an informed decision and talk to their doctor.”
Screening and Diagnosis
The ease of being screened for prostate cancer – a simple blood test – begs the question of why someone would choose to delay or decline screening. Quite simply, there isn’t medical consensus that the potential benefit of early detection and treatment outweighs the side effects of early diagnosis and subsequent treatment.
“Research has shown that for a few men diagnosed with prostate cancer, early treatment may be effective at preventing spread of prostate cancer and help them live longer. However, for many men diagnosed with prostate cancer, treatment is not effective and can cause side effects,” Dr. Trajano says. “So, the question becomes what do you plan to do with this information?”
Blood test screenings are not foolproof. False positive results may suggest that something is awry when the reason for the abnormal result can be harmless. The screening test could miss detecting cancer altogether or detect a very slow growing cancer that may never cause problems even if left untreated.
To confirm a cancer diagnosis, doctors perform a biopsy of the prostate. While biopsies are considered routine, there are risks with any surgical procedure, especially that of infection. A diagnosis with the word ‘cancer’ can be emotional, so it’s advisable to consider the scenarios in advance, Trajano notes.
A pathologist’s review then helps your physician evaluate how likely and quickly the cancer may spread. For more aggressive appearing cancers, doctors will likely recommend treatment with radiation or surgery. If prostate cancer appears more slow growing, your doctor may recommend active surveillance or a “watchful waiting” approach.
Treating Prostate Cancer
“It’s not always possible to determine whether prostate cancer is slow or fast growing. What we do know is that out of 80 men being treated for prostate cancer, three typically benefit from early detection and treatment which can be lifesaving,” says Dr. Trajano. “But physicians don’t have a 100 percent reliable way to predict who those three men might be, and many more men will undergo prostate cancer treatment with no benefit and potential side effects.”
“When choosing weather or not to undergo prostate cancer screening, It’s important for men to consider their personal risk factors and discuss both the benefits and potential harms associated with early prostate cancer detection with their primary care physician.”
Men are encouraged to develop a relationship with their primary care physician, get regular check-ups and proactively discus men’s health issues like prostate cancer screening with their doctor.