Tip/Thought of the Day

Tip Of The Day: Sorting Through Conflicting Info On The Necessity Of Prostate Exams

To test or not to test -THAT is the question!

The prostrate gland sits below the bladder in men and contributes to the fluid production in semen. It’s one of the most common cancers in men, but it is unusual because of it’s wide range of consequences. Some cancers are so slow growing they never cause symptoms or threaten life.

Annual physical prostate checks for asymptomatic men are imperative between the ages of 50-69, and as early as 40-45 in high risk males – ask your provider. But, recently there’s a controversy over whether we should be drawing a PSA (prostrate specific antigen) from the blood.

With all the recent articles on this topic I imagine you’re pretty confused. No one specifically came out saying don’t test, but then again they didn’t so do test! So what’s a guy to do?

PSA levels are not specific for prostrate cancer or the more aggressive form. According to a recent JAMA (Journal of American Medical Association) article, the more aggressive form of cancer is found approximately 30%  of the time in diagnosed prostrate cancers. In one randomized screening trial of 162,388 patients, 20% went on to get a biopsy due to an elevated PSA, but cancer was only found to be positive in 1 out of 4 of those biopsies performed. And in those positive biopsies for cancer, 70% were the low grade, nonaggressive form. These results can lead to serious concerns about following up with invasive procedures that may cause impotence and urinary incontinence. Most prostrate cancers appear to be slow growing and ultimately not the cause of mortality. In a recent JAMA article, it was shown that 1 in 3 men who died of OTHER causes also had prostrate cancer at autopsy; meaning other medical issues caused death before the prostrate did.

So what’s the answer? The US Preventative Services Task Force (USPSTF) concludes with moderate certainty that for men 50-69 years, the potential benefits and harms of screening for prostrate cancer is closely balanced.

Screening issues should be discussed between patients and providers and made on individual preferences, values and risk (African American males are more likely to harbor the aggressive form of prostrate cancer and have twice the risk of death from a positive diagnosis, compared with men of European American ancestry and those with a family history of prostate and some other forms of cancer). It is not recommend for men older than 70.

I’ve always felt data is not specifically the issue. It’s what we choose to do with it. I believe more data can assist in making a decision that best fits your situation. Remember, the PSA lab is only one part of the diagnostic puzzle- symptoms, exam, history, and risks all contribute to the process.

Discuss it with your provider and ask all your questions- then you’ll be ready to make an informed decision.

dsc_0323    -Dr. Courtney

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