Prostate Cancer Screening: What to Know Before You Decide to Be Screened

Prostate cancer can be deadly. The American Cancer Society estimates that nearly 35,000 men will die from the disease in 2022. However, most prostate cancers are found early, before it causes symptoms that indicate it has spread elsewhere in the body. That’s when treatment has the best odds of success.

But if your prostate cancer did not cause symptoms, how did your doctor know to look for it in the first place? Doctors identify most early cancers through screening. That sounds like a good thing, right? It’s not an easy question to answer. Here, we’ll discuss the pros and cons of screening for prostate cancer and show why the decision to get screened requires careful consideration. We’ll also tell you what to expect if you decide to get screened.

What Is prostate cancer?

Your prostate is a walnut-sized gland that sits below your bladder and in front of your rectum. It has a role in reproduction. It helps to produce semen. For largely unknown reasons, cells in your prostate can begin to grow out of control and form tumors. It’s mostly a disease of older men. About 75 percent of men diagnosed with the disease are over 65.

Often, it grows slowly and does not cause harm during a man’s lifetime. In fact, 99 percent of men diagnosed with the disease live with it for more than five years. Most men die of other causes, including old age, before cancer becomes a concern. They might never have known they had it.

Why is screening a difficult decision?

This is where screening gets complicated. If you get screened and learn that you have cancer, your doctor will not be able to tell you what course your cancer will take. Will it be aggressive and potentially deadly? If so, it requires immediate treatment. But if it remains dormant and never causes concern, treating it will do you more harm than good.

What are the risks of overtreatment?

The most common ways to treat early-stage prostate cancer - surgery and radiation - both have serious, potentially permanent side effects such as erectile dysfunction, urinary difficulties, and problems with your bowel movements.

Even if you don’t opt for treatment and decide it’s best to wait and see if your cancer does get worse, you still have to live with the anxiety of knowing you have cancer. You’ll also likely have to undergo regular tests to keep an eye on your cancer, including biopsies. These surgical procedures remove small samples of tissue from your prostate for examination in a lab. There is a small risk of infection, urination problems, and bleeding after each biopsy.

What happens if the screening test is wrong?

Another risk of screening: The tests involved can return a false positive. That means that your screening exam mistakenly suggests you have cancer. That can lead to further testing, including a biopsy, which may be harmful as noted above. It also can cause unnecessary anxiety as you wait to learn the test results. Research has shown that if you get screened every two to four years over a ten-year period, you have a one in six chance of at least one false positive.

On the other hand, screening tests also can result in a false positive. This means that you do have cancer, but the screening failed to recognize it.

One more thing to consider. Experts don’t yet know whether screening will reduce the risk of dying from prostate cancer. So far, studies have not been able to provide definitive results.

Should you get screened?

You will have to decide for yourself or let your doctor make the decision for you. Before reaching a decision, though, have a thorough conversation with your doctor. Together, you can review what makes the most sense for you based on any prostate cancer risk factors that you may have. Three risk factors stand out:

• Your age. As mentioned above, prostate cancer occurs much more commonly in men aged 65 and older. But older men are less likely to live longer even if their cancer is discovered because they have a better chance of dying of another cause before their prostate cancer does them harm. Younger men, on the other hand, may benefit more from treatment given their longer expected remaining lifespan.
• Your race/ethnicity. African-American men have a higher risk of prostate cancer and a higher risk of dying from the disease.
• Your family health history. If your father and/or one or more brothers had prostate cancer, your risk is higher because a genetic cause may run in your family.

You and your doctor also will discuss the pros and cons of treatment so you have a full understanding of what to expect if you decide to go ahead with screening.

When should you discuss screening with your doctor?

The American Cancer Society makes the following recommendations.

• Age 50. If you are a man who has an average risk of prostate can and you are expected to live 10 or more years longer (ie, you are in good health).
• Age 45. If you are African American or your father or a brother had prostate cancer before the age of 65.
• Age 40. If you have more than one first-degree relative (father or brother) who had prostate cancer before the age of 65.

Some organizations recommend against screening men older than 70 because prostate cancer often grows slowly so they are more likely to die of old age or other causes and treatment is likely to do more harm than good. The American Cancer Society recommends considering a man’s overall health and how long he’s expected to live, not just his age, when deciding whether to screen.

What does screening involve?

The screening procedure may involve just a blood test. This measures a protein found in your blood called prostate-specific antigen (PSA). If your PSA measures above 4 nanograms per milliliter, your likelihood of having cancer rises. Your doctor may order a second PSA to confirm the results of the first.

You may also undergo a digital rectal exam (DRE). During this exam, your doctor will examine your prostate with a gloved finger, looking for bumps or other abnormalities. The DRE is not as reliable a test as the PSA, but it may reveal cancers in men whose PSA test results are normal.