Screening for Prostate Cancer

 

How do you effectively screen for the most common cancer in American men and keep costs reasonable? Also, realize that many men will get prostate cancer (~16%) but few will die from the disease.

 

In general, most urologists recommend screening if life expectancy is 10 years or greater. It is simple if we look at this at extremes of age. For example, a man who is 50 years old presents for a "prostate check". It is very reasonable to assume that he will see his 60th birthday. However, if a patient is 80 years old and is wondering if he should continue with screening, he is less likely to see his 90th birthday.

 

What are the facts that come up regarding screening?

 

As a man gets older, the chances of getting prostate cancer gets higher. There are some who believe that if a man lives long enough, he would eventually get prostate cancer. The younger you are and if you develop prostate cancer, the more likely it is an aggressive form of the disease.

 

As prostate cancer develops, it is believed to stay within the boundaries of the prostate until such time it grows outside of the capsule of the prostate thus becoming metastatic. It goes from a possible cure to an incurable disease.

 

The costs associated with screening is huge (tens of billions) in America. Screening causes patient anxiety.

 

Does screening reduce the amount of deaths from prostate cancer? This is yet to be determined. 2 studies are looking into this 1. PLCO (Prostate Lung, Colorectal and Ovarian screening study) and 2. Rotterdam Screening Trial. These studies are to be completed in about 8 years.

 

PSA is a blood test that was started in the late 1980's. At first there was a hugh increase in previously undetected cancers. What we are seeing now is a fall in metastatic disease. Over the next couple of years, we should expect a fall in mortality. The SEER Trial (Surveillance, Epidemiology and End Results Trail) shows a decline in the annual reduction in prostate cancer mortality.