Generally speaking, only men have prostate glands, but those of you who don’t might want to read on anyway, because what happens to 49% of us affects the other 51% – that is, the women in those prostate-packin’ men’s lives. Lately, there has been some controversy about whether men should be screened early for prostate cancer. Let’s look at why.
In general, gurus of health care wisdom think that screening for early detection and treatment of disease is a very good idea. We can save folks a lot of pain, suffering and money if a disease is recognized early on and treated as soon as possible. Screenings come in different forms: lab tests, questionnaires, x-rays or looking directly into the body. For example, you might have a blood test to check your levels of bad cholesterol (LDL). If they are high, you can be more aware of the possible problems this may cause you later on in your life and do something about it. A change of diet, and/or adding cholesterol-lowering medicine, may keep a person from having a heart attack or stroke.
So far, the availability of this type of screening and prevention for heart diseases has proven to be a good thing. There are several cancers we screen for as well – a mammogram (type of x-ray) screens for breast cancer, a colonoscopy for colon cancer (looks directly inside the body at the colon), and a Pap smear screens for cancer of the cervix (only women have those) by putting a few cells in a container and sending them to a lab. These are all good tests that can give an early diagnosis for a future problem so it can be dealt with before it becomes a bigger issue.
Until recently, we thought that screening for prostate cancer was also a good thing. When the PSA (the blood test used to screen for prostate cancer) was invented and became available, the health care community was thrilled. It really seemed that this was a breakthrough that would save many men’s lives. At first we thought the blood test would take the place of that awful rectal exam, but it turns out that it was still necessary to feel the prostate with a finger because sometimes the blood test was wrong and the rectal exam indicated a problem that needed further investigation (if it’s any consolation, doing a rectal exam is not any more fun for me or my fellow health care providers than it is for the person on the receiving end of it).
What’s happening now is that the United States Preventive Services Task Force (USPSTF), the organization that looks at all the research studies about particular screenings to decide if they are really worth doing, has determined that the PSA is no longer worth recommending. How can this be, you ask? Well, it takes time and lot of people gathering data about an issue to determine how well things are going. And the data, unfortunately, is telling us that doing this test on all men as part of their routine health care is not really saving lives.
There are often many more problems caused by doing the screening than we’d like, and the disadvantages often outweigh the advantages. For example, since prostate cancers are often very slow growing, a man will die of something else long before a prostate cancer will kill him. If the screening is done, however, it forces the man and his health care provider to choose a next step. Richard Ablin, the inventor of the PSA test, has referred to it as a “public health disaster.” Why? Because it is a rare person who can sit comfortably with the knowledge that he has a cancer but doing something about it may actually cause more problems than the cancer itself.
So, that “next step” I mentioned above is a biopsy. A biopsy is the removal of a little bit of tissue from the prostate (ouch!) which is sent to a laboratory to see how healthy the cells in it are. If cancer cells are found, the step after that would be to decide how to kill the cancer – radiation, surgery or chemotherapy? The very unhappy adverse effects of these treatments can be urinary incontinence (being unable to control the urine leaving the bladder) and erectile dysfunction (inability to maintain an erection). Some men can also develop problems with their bowels, depending on the type of treatment they chose to have.
So, what’s a man to do? The best advice is to make sure that when you have your annual check-up you speak with your health care provider about it – let him/her help you decide what you want to do, rather than just having the blood test done without thinking very much about it. Some medical organizations think it’s crazy to stop doing PSA tests, while others think it’s crazy to continue. Obviously, there is some confusion about the best way to proceed. One recommendation that has been made is to only be screened if you are at higher risk for prostate cancer – if you are African American and/or a man with a family history of prostate cancer.
It’s always best to have good information before you make a health care decision. Talk it over with your health care provider to see what the latest recommendation is. Some men decide to delay screening; some men want to only check every few years instead of every year; some men don’t want to do it at all and prefer to take their chances with a cancer that may not ever cause them difficulty. The bottom line is to know what you’re being tested for and to make a conscious decision about it beforehand. After all, it’s your life and, ultimately, you make the decision about your health care. Good luck – whatever road you choose!