Prostate Cancer Screening

Cancer of the prostate has long been the most common malignancy in men. Recently, we are seeing a significant rise in the discovery of new cases. This is attributed to the increased public awareness, the media hype when celebrities get afflicted with the disease, and the program called Prostate Cancer Screening.

In screening for prostate cancer, the urologist takes a careful history. Of particular importance is the sudden onset of voiding symptoms such as frequent urination and urgency. Unexplained bone pain and weight loss should be dealt with seriously, as silent prostate cancer often initially manifest with spread to the bones. The most useful single test is the digital rectal exam or D.R.E. This can detect cancers that are large enough to produce a lump or nodule or change in consistency of the gland and those that are on the surface. Another test that we routinely include in screening is the P.S.A. Most prostate cancers, small or large produce abnormal amounts of prostate specific antigen (P.S.A.), which is easily measurable in the blood. This has provided us the capacity to diagnose the cancer very early in its course.

Most urologists who are advocates of Prostate Cancer Screening agree that we should screen all men over the age of 50 on an annual basis. Because of familial tendency, men with family history (brothers, father, or uncles with prostate cancer) should start the screening at age 40. African American men also appear to have a higher incidence of prostate cancer and they get affected earlier in life. We therefore start screening African Americans 10 years earlier.

From the time we started screening for prostate cancer, there has been a controversy on whether to consider this as a standard health care practice. We know that this allows us to detect the cancer in its very early stages, which gives the patient a better chance of cure. Opponents of the idea look at the whole picture. The cost to society is enormous. It increased the number of unnecessary biopsies (perormed for a slight elevation of the P.S.A. but yielding no cancer). There is also a question of the validity of the treatment of those patients whose cancers were diagnosed very early as a result of screening. Would the final outcome as far as life expectancy or quality of life be improved?