Make an informed decision on prostate cancer screening

Prostate-Specific Antigen (PSA) is a protein produced by prostate cells. Because prostate cancer cells can produce 10 times as much of this protein as a normal prostate cell, a blood test for PSA was approved by FDA in 1986 to monitor patients who had already been diagnosed with prostate cancer. 

In 1994, it was additionally approved for use in conjunction with a digital rectal exam to screen men aged 50 or older for prostate cancer. Since about 2008, however, how best to use the PSA test to screen for prostate cancer has been controversial.

After skin cancer, prostate cancer is the most common cancer in men. Its incidence increases with age, and autopsy studies have found microscopic evidence of it in nearly 80 percent of men over age 80 who died of other causes. Most prostate cancers are very slow-growing, and most men in whom low-grade prostate cancer is detected will die of other causes — with the cancer rather than of it. However, there are high-grade, more lethal cancers that make prostate cancer the leading cause of cancer death in men over the age of 50. With the PSA test, potentially serious cases of prostate cancer can be found early.

Following the example of widespread publicity about the value of mammography in screening women for breast cancer, a similar national public campaign of screening for prostate cancer was undertaken in the 1990s. The result was a dramatic increase in the number of prostate cancers diagnosed. Most of these were low-grade and would never have otherwise been detected. However, in the mid-1990s, any diagnosis of prostate cancer in an otherwise healthy man was treated with either surgery or radiation. In retrospect, the complications and side effects of treatment of these slow-growing cancers outweighed the benefits. This led the United States Preventive Services Task Force (USPSTF) to recommend against PSA testing of men over 70 years of age and selective testing of men aged 55 to 69 at higher risk, such as African Americans and those with a first-degree relative who had prostate cancer. Following this recommendation, however, would miss high-risk prostate cancers among other groups of men.

Early detection of high-grade cancers, coupled with newer treatment options with significantly lower complication rates, now drives efforts to screen healthy men, even as they age beyond global algorithms. The American Cancer Society recommends that men make an informed decision with their health care provider about whether to be screened for prostate cancer after learning about its risks and potential benefits. Detailed information about PSA screening can be found at the National Institutes of Health website (cancer.gov).