Let’s suppose you’ve just celebrated your 50th birthday. Part of the “fun” of fifty involves facing facts about your health. Your doctor recommends a colonoscopy, for example. Your doctor may also ask about prostateThe prostate is a walnut-sized gland located between the bla... Full Definition cancerCancer is a group of diseases where cells grow abnormally an... Full Definition screening using a PSA test. This is not a standard test that is given to all men of a certain age, so it is up to you to decide if you want it or not.
One of the reasons that the test is not given to every man is that there are conflicting results as to the benefits of prostate cancer screening. Studies help medical boards decide whether screening is worth it for the healthcare system, but it doesn’t necessarily mean that screening has no value for you as an individual. For some men, screening leads to lifesaving treatment.
There is an often-repeated misconception about prostate cancer: many men believe that most men who have prostate cancer will die with prostate cancer, but of something else. Although this is true for some patients, it is not true for others. The truth is that prostate cancer is the second leading cause of death from cancer in men in the US.
It is also true that prostate cancer is often a slow-growing disease. But like breast cancer and many other cancers, there are many forms of prostate cancer, some worse than others. Some doctors wish that the slow-growing form of the disease could be called something other than cancer to make it easier for them to communicate clearly with their patients. The word cancer itself can cause such anxiety and stress in some men that it is difficult for them to hear much else.
So the first thing to understand when considering screening is that the test could give you a chance to find and treat life-threatening prostate cancer.
Before going forward with screening, however, ask yourself what you will do with a positive test result. This is important for all forms of cancer screening. A positive result changes everything.
Here are a few scenarios to help illustrate the possibilities:
In the case of prostate cancer, a positive result could lead to lifesaving treatment. For instance, suppose a very healthy 55-year-old man has just discovered that he has prostate cancer. His doctors put him in the intermediate risk category. The disease is still confined to the prostate, but is large and his PSA numbers have been rising, suggesting that the tumorA lump or swelling caused by abnormal growth of cells. Not a... Full Definition is growing. Immediate treatment could eliminate the cancer.
It could also turn out to be a false positive. As an example, a 75-year-old man receives a call from his primary care doctor after a physical. The doctor performed a PSA test and the results have come back higher than normal. The man sees a urologistA doctor who specializes in the urinary and male reproductiv... Full Definition, who performs additional diagnostic tests. It turns out that there are no signs of cancer. The man is simply experiencing a normal increase in PSA as he ages.
And it could turn out to be the beginning of a new lifestyle of active surveillance, where testing becomes a necessary and regular part of your yearly routine. In this case, a 67-year-old man in good health is diagnosed with a low-risk form of prostate cancer. Rather than opt for treatment to remove the tumor, the man chooses active surveillance. He agrees to have his PSA levels tested and to undergo regular diagnostic testing to make sure the cancer is not advancing (traditionally this would include biopsies, but other, less-invasive testing such as MRI is an option in certain situations. It’s worth asking about!). If it does, he’ll consider treatment.
What doctors hope to avoid when screening men for prostate cancer is a downward cascade that leads to worse health rather than better health. This can happen, even when you and your doctor think you are making your very best decisions.
The more you and your doctors discuss your condition—not just the details about your cancer, but also the health of the rest of your body—the more likely you will receive treatment that benefits your life and fits your lifestyle.