Benefit vs. risk in prostate cancer screening

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Q: What are the benefits and risks associated with prostate cancer screenings?

A: Prostate cancer is one of the most frequently diagnosed cancers among men and a leading cause of cancer-related death, but screening for prostate cancer has not been very useful in detecting the disease early.

Screening for prostate cancer uses a blood test called prostate specific antigen (PSA). Elevated levels of prostate specific antigen might be a sign of prostate cancer; however, it also might be caused by non-cancerous conditions.

The PSA has a very high false-positive rate, which means it might show cancer when you do not have cancer.

The PSA might reduce your chance of dying from prostate cancer, but the evidence is mixed and the benefit might be very small. In fact, the United States Preventive Task Force and some other health organizations recommend against routine screening for prostate cancer in men at low risk for developing the disease.

The risks associated with prostate cancer screening include unnecessary testing and procedures, if your PSA is positive; unnecessary costs; and the increased anxiety of wondering if you actually have cancer.

For those who choose to get tested, healthcare providers generally recommend screening begin at age 50 for men with an average risk. This should include a digital rectal exam (DRE) and a PSA.

African-American men and men with a family history of prostate cancer are at a higher risk. They should begin screening between the ages of 40 and 45. These higher-risk groups are most likely to benefit from screening.

If you have an abnormal DRE or an elevated PSA level, you might be referred to a urologist who can perform a prostate biopsy. This is the best way to diagnose prostate cancer. Follow-up screenings generally are repeated every two to four years.

Typically, screening is not recommended after age 70. Because prostate cancer can be slow growing, many men who are diagnosed with it choose not to get treated. Often, older men with prostate cancer eventually die of unrelated causes.

Talk to your healthcare provider to determine if you would benefit from prostate cancer screening. Depending on your age and risk, you might decide screening is right for you or you might choose to skip it.

Get the facts so you can make an informed decision.

Heather Barnard, FNP-C, is a board-certified family nurse practitioner who sees adult patients at Memorial Health University Physicians - Legacy Center in Okatie.

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