Why is Screening So Controversial?

There is indeed a dilemma surrounding the diagnosis and treatment of this insidious and potentially life-threatening disease. The prostate specific antigen (PSA) and digital rectal exam (DRE) are imperfect indicators, yet the death rate from the disease has consistently decreased since the inception of the blood test in the early 1990s. Fortunately, there are promising new discoveries that will eventually allow physicians to more accurately differentiate the life-threatening cancers from the less threatening.

Some professional organizations, such as the American College of Physicians, the Canadian Task Force on Preventive Health Care and the U.S. Preventive Services Task Force, do not recommend regular screening. They believe that some of these cancers may never affect a man’s health and treating them could cause temporary or long-lasting side effects such as impotence and incontinence.

The American Urological Association (AUA), American College of Radiology, College of American Pathologists, National Comprehensive Cancer Network (NCCN) and the Arkansas Prostate Cancer Foundation (APCF) Medical Advisory Committee recommend otherwise. They believe current scientific evidence shows that finding and treating prostate cancer early, when treatment might be more effective, may save lives.

The (NCCN) consists of world - class cancer treatment centers including Johns Hopkins, MD Anderson, Sloan Kettering, Stanford, Vanderbilt and Duke. They have combined their considerable statistical data to conclude that when factors such as age, ethnicity and family history are taken into account, the PSA can be helpful in finding aggressive cancers.

The facts remain that Arkansas’ men are now more likely to die from prostate cancer than Arkansas’ women are from breast cancer1, the premature death rate from prostate cancer has increased by 55% (before age 65), and African American men and those with a family history have a significantly higher risk2. Sometimes the problem is that many know their male relatives died of cancer, but did not know it was prostate cancer — men simply do not talk about it.

The APCF Medical Advisory Committee, composed of urologists, radiation oncologists, an internist, and a rehabilitation specialist — three of whom are prostate cancer survivors — accepts the guidance of the NCCN and the AUA, both recommending a baseline score at age 40 with follow up in 6 months to 5 years based on the results.

If the baseline or subsequent scores are suspicious based on age and ethnicity, the PSA will be repeated every 3-6 months to evaluate velocity. They further recommend that screening after age 75 should be considered individually.