For the prevention of most cancers, regular screening is encouraged. But a local doctor says that in the case of prostate cancer, screening may have more drawbacks than benefits for the general population of men.
Dr. Phil Agent, a board certified physician in internal medicine at Mercy Fort Smith, says when it comes to screening for prostate cancer, men should not necessarily pursue screening unless there is a clear reason to.
Some clear reasons for screening include being a male who is African American or a male with a strong family history of prostate cancer, Agent said. These factors put men in a high-risk category for developing the cancer. Screening is also recommended for men between the ages of 55 and 70 years old.
But, for the average male younger than 55 and older than 70, a Prostate-Specific Antigen (PSA) test — the common test for prostate cancer — may not be necessary.
“Screening is only meaningful when the pre-test probability (of having cancer) is meaningful,” Agent said. “We need to do the test on someone that is likely positive.”
Screening for prostate cancer is a blood test that checks for an antigen released in the blood that is produced by both cancerous and benign prostate tissue, according to information from the Mayo Clinic. An elevated PSA level can, but does not always, indicate prostate cancer.
Agent said there are a number of other things that can elevate PSA levels in men including infection, sexual activity and physical activity, among others. So screening when it is not likely that a man has prostate cancer can result in a false positive, which in turn can lead to additional medical testing that is unnecessary and expensive. It can also elevate the stress level of the patient who may become anxious about test results.
Men who are not at high risk for prostate cancer, and not in the age range that is recommended for screening, should understand that if they choose screening, an elevated PSA in itself is not necessarily a reason to panic.
“If you have a prostate, you’re going to have a PSA level,” Agent said. So looking at a change in that level over time is the best measure of whether additional steps need to be taken.
Agent added that for men whose elevated PSA level may indicate that they do have prostate cancer, sometimes not having that information could actually be beneficial.
“Not knowing the answer is often better than knowing,” Agent said.
Prostate cancer is a unique cancer because of its likelihood to be slow growing, Agent said. Because of its slow-growing nature, he said the problem often becomes that it is less clear what to do about something that may not be life-threatening, but is still cancer.
“You don’t have to do something right now all of the time,” he said.
However, Agent said he is not advocating “doing nothing.” When treatment is not the best option immediately, he said setting a baseline with a PSA screening and getting plot points with follow up testing will allow a patient to make an educated decision about when it is the right time to pursue treatment.
Agent cautioned that not every case is the same and the disease can range from a non-aggressive Stage 1 disease all the way to a very aggressive tumor. There are different variations of the disease specific to how people respond to it.
The two most common treatments for prostate cancer are robotic surgery and androgen deprivation therapy. Agent said both have consequences that affect quality of life.
Robotic surgery is typically performed when the cancer is confined to the prostate while ADT is typically used in more advanced cancer. While men can retain their sexual functionality after robotic surgery, there is still a risk of sexual and urinary dysfunction, Agent said. It is less likely that they will retain functionality while undergoing ADT, he said.
Men should not use recognizing symptoms as a way to screen for prostate cancer, as there are typically none, Agent said. A man usually experiences symptoms that accompany prostate cancer only after they have developed advanced disease.
Agent said it is best to look individually at men under 55 and older than 70 to make a decision about whether screening is best. But as a general rule, most patients outside the recommended age-range for testing, and without elevated risk, should not be tested.