Prostate cancer is the second leading cause of cancer-related deaths for men. It is the most common form of cancer in men. And one in seven men will be diagnosed with prostate cancer in his lifetime.
Like any cancer, the earlier prostate cancer is detected, the better the chances for treatment and survival, says urologist Dr. Ralph Miller, of Triangle Urological Group in Pittsburgh. With numbers like those, it would seem to make sense for every man to take advantage of the prostate-specific antigen (PSA) test, which checks for early signs of prostate cancer.
The PSA, however, has been the center of great debate in the last few years, Miller says, especially among official medical communities. Among the seven major national medical organizations that usually have a policy on testing, policies about the PSA range from extremely negative to moderately positive, Miller says. “A few years ago, the attitude nationally was, ‘Let’s screen everyone.’ But in recent years, the medical community has taken a closer look,” Miller says. “There are some cases when the testing may be more risky than the prostate cancer.”
Miller gives the example of a 78-year-old man with a history of two heart attacks. Even if his PSA is positive and the patient is diagnosed with prostate cancer, the testing and treatment could cause further health issues. “That case would raise red flags,” Miller says. “Prostate cancer runs its course in 10 to 15 years. Those tested should have at least that life expectancy themselves.”
While there are some medical organizations that are recommending totally against screening, Miller doesn’t like that idea, either. “That is just as bad, in my opinion, as the thought that everyone should be tested,” he says.
So, who should be screened for prostate cancer? Miller says the PSA testing makes sense for men 50 to 70 years of age who are proactive about their health. “The guy who is proactive about his health—someone who watches their blood pressure and their cholesterol, who works out and eats right—is going to be the kind of person who gets a PSA,” he says.
There are also certain populations who have a greater risk of prostate cancer and should be tested earlier, including those who have two or more family members who have had prostate cancer. Also, African-American men may want to start testing at age 40, as there is a higher rate of prostate cancer among that population.
Miller suggests that men be tested once per year, during their annual physical. The testing consists of a blood test and a prostate exam. “Four-fifths of cases are detected by the blood test and one-fifth from the exam, so I obviously recommend both,” he says.
Despite an aging population in which you would expect see more cases of prostate cancer, the number has dropped since PSA testing began, Miller says. “That would show me that something is happening to cause a drop in these numbers, and to me, the most plausible is early detection thanks to testing,” he says.
Miller suggests every man make an educated decision, and talk over the testing with his own doctor.
