Prostate cancer (PC) is the most diagnosed form of cancer in American men. Each year there are roughly 200,000 men that are diagnosed with PC and over 30,000 will die from it. In many respects, PC is the mirror of breast cancer in women. It is a hormone-sensitive cancer that will affect at least one out of every six men now living in the United States.

Most PCs are slow growing; however, there are cases of aggressive PCs. The cancer cells may metastasize (spread) from the prostate to other parts of the body, particularly the bones and lymph nodes. Next to lung cancer, in men PC is the second leading cause of death due to cancer.

The big push conventional medical circles will make this month is encouraging men over the age of 50 years to see a physician for two tests:

  • A digital rectal exam–the doctor inserts a lubricated, gloved finger into the rectum and feels the prostate through the rectal wall to check for hard or lumpy areas.
  • A blood test for prostate-specific antigen (PSA)- which will usually be elevated in men with PC. A normal PSA ranges from 0 to 4 nanograms per milliliter (ng/ml). A PSA level of 4 to 10 ng/ml is considered slightly elevated; levels between 10 and 20 ng/ml are considered moderately elevated; and anything above that is considered highly elevated. The higher the PSA level, the more likely it is that cancer is present. However, approximately 35% of men with diagnosed PC will have a “normal” PSA of less than 4. The level of prostate-specific antigen (PSA) in the blood tends to rise with PC, but minor elevations may be due to less serious conditions like prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH) (enlargement of the prostate).

However, recently there has been a bit of controversy regarding the fact that screening for prostate cancer has led to harming many more men compared to the number that have died from prostate cancer. Many doctors will state that the rationale for early detection of prostate cancer is that it leads to more effective treatment. Unfortunately, the data on PSA screening for PC does not support this notion. Several reviews on the impact of PSA screening show no statistically significant difference in death due to PC between men randomized to screening and those who were not screened.In fact, the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force believe that PSA screening produces more harm than good based upon very extensive analyses.

Harmful effects of screening included high rates of false-positive results for the PSA test resulting in over-diagnosis and the adverse events associated not only with biopsies (such as infection, bleeding and pain), but also in the treatment of PC with chemotherapy and radiation. It is believed that in most cases, the PC would not have seriously affected many lives if it had simply been left alone. Most PCs are extremely slow growing meaning that men can live with PC, rather than die from it. In fact, autopsy studies report that more than 30% of all men over the age 50 have evidence of PC, but only 3% will die from it.

My feeling is that the problem with early screening is not the screening; it is what happens after the screening that is the issue. In the case of PSA screening, the approach should be “watchful waiting” versus immediate biopsy unless accompanied by significant recent increase in PSA levels, family history, or in African-Americans. And, if the biopsy is positive, even then a conservative approach should be taken with the majority of men. Now, that does not mean that I advocate idleness with “watchful waiting.” In fact, I recommend just the opposite; focus aggressively on the  preventive measures against PC detailed here:

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