The research you need to understand for prostate health.
Especially for men over 50, discussions of prostate health are inevitable and it is a major health concern for middle-aged and older men. In the past, because of this concern, PSA tests were routinely done, even on men who were not at an elevated risk. Now, attitudes are changing and doctors are rethinking their use of this test.
The PSA in Context
While the PSA test may be controversial in some cases, what everyone can agree on is that prostate cancer is an important issue for men’s health. According to Healthline, the prostate is the small gland which surrounds the urethra, the tube through which a man passes both urine and seminal fluid. Cancer occurs when these prostate cells begin to grow abnormally and form tumors and/or spread to other parts of the body. This growth can either be slow or very rapid and aggressive, depending on the type.
The numbers are enough to make any man sit up and take notice. Per data from the American Cancer Society (ACS):
- There are 180,810 new cases of prostate cancer each year — and approximately 26,120 deaths.
- 1 in 7 men will be diagnosed with prostate cancer in his lifetime.
- Prostate cancer is the second leading cause of cancer death among American men, second only to lung cancer.
Healthline also notes factors like a man’s age (being over 55), a family history of prostate cancer, certain racial backgrounds (such as African American) and being overweight can all put a man at a higher risk for developing prostate cancer. Even for men at higher risk, however, there are few if any early signs and symptoms. These do not occur until the condition is more developed and can include urinary problems (an increased urge to urinate combined with difficulty in starting a stream or bloody urine) or sexual ones (like the inability to achieve or maintain an erection). If the cancer has spread, pain in the pelvic area is also common.
The PSA test was once widely used to screen men for prostate cancer, but this has fallen out of favor in certain cases. Let’s take a look at why.
The PSA Controversy
The Cancer.net website reports that the PSA controversy centers on this question: should this test be used to screen men who have no signs and symptoms of this disease? This questions continues to be the subject of fierce debate. On the one hand, there is no denying that the wide use of the PSA test in the past was able to detect the cancer in its earlier stages and thus reduce the number of cancer deaths.
The problem, however, is this: the broad use of the PSA has also led to a dramatic rise in the number of unnecessary biopsies and treatments, since 75% of men who undergo a biopsy do not test positive for cancer and of those who do, many have the slow-growing, non-aggressive kind that does not pose a serious threat. On the other hand, these treatments and biopsies can lead to serious problems themselves, including infections and long-term troubles like impotence and urinary incontinence. Needless to say, these can seriously impact a man’s quality of life.
Based on the potential for poor patient outcomes related to unnecessary treatments, the American Society for Clinical Oncology (ASCO) has revised its recommendations for PSA testing. It states:
- For men without signs and symptoms of prostate cancer and who are expected to live at least 10 years, general screening is discouraged.
- For men with less than 10 years to live, a discussion on the pros and cons should be had with a doctor before a PSA test is given. This should be done so that a man fully understands his options and the risks and benefits of his choice.
Healthline also notes that it is not just ASCO which has dropped its support for routine PSA screening. The American Urological Association and the U.S. Preventative Services Task Force no longer recommend the wide use of PSA, either.
In short, there’s a lot at stake here. On the one hand, early detection of cancer is important for treatment. On the other hand, no one wants to become impotent or incontinent due to unnecessary medical procedures. So what’s a guy to do? The best advice is to make sure to sit down with a doctor who is very familiar with his patient’s medical and family history and to weigh the benefits and drawbacks of this test carefully. This can help each individual man decide if PSA screening is worth it — and to feel comfortable and rest easy in that important decision.