Prostate Cancer Screening -- Necessary or Unnecessary?

I've always heard that the conventional wisdom was that when you turn 40, you should start planning to get a prostate cancer screening.

But my doctor told me today that the conventional wisdom may not be that wise.

I'm fortunate to have a physician that is a no-B.S. professional. He will tell me straight up what's up; he won't treat a patient who is not sick; and he is really skeptical of insurance and pharmaceutical companies to say the least. He's kept me and so many others healthy because of his attitude toward his practice and his patients. Needless to say I've learned to trust the guy with my well-being.

So when I told him I turned 40 recently and that I thought I should get a PSA test, he told me "not so fast" and pointed out to me that getting the test may lead to proper treatment and prevention, but it has just as much chance of leading to overtreatment and unnecessary complication.

My father once had prostate surgery, but my doctor says even if it's hereditary, it doesn't mean I'll be diagnosed with it. Indeed, as I've done my research I'm finding many in the medical community questioning the necessity of constant prostate screening.

I mean, I have no reason to think I may come down with prostate cancer, and if I take a test and they find something that might not even be cancer and take treatment then I may well suffer adverse effects.

On the other hand, if I take it and they do find something, I could either a) live with it and likely die 60 years from now of something else; b) take the treatment and save my life; or c) die of prostate cancer within the next five years.

The doctor's argument did sound reasonable, and he didn't tell me not to get the PSA, he just said I could choose to do it or not to and that it might not really make any difference long term if it don't. But at the same time, if I do, I run the risk of treatment that might be ultimately detrimental.

Those of you who have made the decision to get the screening, what motivated you to do so? Do you wish you hadn't? Do you think the screening made any difference? What might have happened if you chose not to?

Thanks.



Tags: Cancer, Prostate, Screening

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My father's screening caught his very aggressive prostate cancer before it could kill him. Even though he had it removed, he still has a 50% chance of having it reoccur. It's worth the test.
I recommend this to everyone - go read the book Overtreated and then make the decision for yourself.

Topher is right - it's a screening test, though not a very good one. It produces a lot of false positives.

I am very involved in PCa work because of what happened to me.  (My understanding now is that African Americans should begin PSA tests at age 40 and other men at age 50.)

I had my first PSA as part of my annual physical when I turned 50, and it looked a little unusual.  So the next year I had it done again, and it looked even more unusual.  They did a biopsy followed by a more thorough digital rectal exam than before and found that I had cancer in my prostate.

Of all the options that were available to me I chose surgery, which I had done in 2000.  That makes me a 12-year cancer survivor.  Thank you, God!  (Contact me privately if you would like to know why I chose surgery over the other options.  And if you'd like to know how I overcame common post-prostatectomy side effects.)

I know that a PSA test is not perfect; no medical test is (as far as I know, as I am not a medical professional myself).  Any doctors worth their salt would follow a suspicious PSA with another one, and then do a variety of other tests before making a diagnosis and discussing options with the patient (and the options include active surveillance, aka watchful waiting).

No doctors worth their salt would say, "Oh, your PSA is [a certain number].  That means you have prostate cancer.  Let's do surgery/radiation/chemo/hormones."  A PSA number is not a magic tell-all finding.

All I know is that since prostate cancer does not have symptoms (until it has spread to the bones and then it's too late), PSA tests saved my life (and the lives of quite a few other men I know).  But of course what persons do with their own bodies is up to them.  A person's body is extremely personal, isn't it?

Screen, if you have it then assess the situation.  Some cancers are so slow as to not be a problem, some are not.  There is a concern about over treatment. 

Trust me on this.  You really need to keep the old body's systems checked.  It's analogous to checking the underhood fluids in your car.

Far, far better to discover that your enlarged prostate (yes, I am that old) is not due to an inoperable cancer.  The one you didn't get diagnosed because you didn't mind peeing half a dozen times a night.

You are wise (and fortunate to be able) to trust your personal physician, but the bottom line is that YOU are ultimately responsible for your health, not your doctor.  Sounds to me like he really cares about his patients.

Learn what the signs of prostate cancer are.  I'm not a doctor, and I don't put myself out there as one.  But 40 does appear to be too young.  Since your dad had it, you might be at increased risk, but your doctor is right: that doesn't mean you'll get it.  Still, know the signs.  Have anything suspicious checked out by a licensed physician.

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