The Cayman Islands Cancer Society is observing November as Cancer Awareness Month for men. In this article, we look at the controversy surrounding screening for prostate cancer and the choices a man must make after consulting with his doctor.
Screening for a disease is likened by some people to going on a fishing expedition as screening tests are done on people who are asymptomatic, in other words with no signs or symptoms of a disease.
Screening for prostate cancer is a controversial issue and no medical or scientific organisation has issued screening guidelines for prostate cancer. There are however two tests often referred to as screening tests for prostate cancer; a digital rectal exam and a prostate specific blood test.
Many men are embarrassed to ask the doctor for a DRE as it involves the doctor inserting a glove finger into the rectum to feel for abnormalities in the size or shape of the prostate. You may recall from last week’s article that the prostate is located in front of the rectum. This test has the limitation that the only area that is examined is the part of the prostate that the doctor can feel.
Many feel that the DRE is an invasion of their body and will not consent to the test. Instead they prefer the option of the PSA blood test. PSA is a protein which is produced only in the prostate so it is specific to this part of the body.
However PSA is not specific to cancer and therefore PSA levels can be elevated for reasons other than prostate cancer – including advancing age. Conversely it can be normal when in fact a person has prostate cancer and therein lies the dilemma. There is no evidence that PSA testing actually improves the lives of those diagnosed with prostate cancer or that it reduces the number of deaths from prostate cancer.
The PSA test is quick and simple and is not viewed by men as invading their privacy. It may detect prostate cancer at an early stage before symptoms appear and at a stage when the tumour is easily treatable. When PSA tests are done on an annual basis they are helpful in monitoring the rate of change of a man’s PSA level. Significant increases especially over a short time may be indicative of prostate cancer.
On the other hand, PSA testing may detect cancers that will never become clinically significant and cause a health problem for a man but will result in him having to undergo potentially risky treatment and the side effects that go with the treatment.
Treating prostate cancer in men over the age of 75 years is unlikely to lengthen lifespan and this may have prompted the US Preventative Screening Task Force to issue a recommendation this past August against screening men older than 75.
Most men with an elevated PSA level do not have cancer, but having received the result of an elevated PSA level a doctor is obliged to do additional investigative studies which have risks and financial costs not to mention the worry it places on a man and his family.
PSA testing can also result in a false sense of security as 20 pre cent of men with early prostate cancer have normal PSA results
The Cayman Islands Cancer Society endorses the recommendations of organisations such as the American Cancer Society and the Canadian Cancer Society that all men aged 50 and older discuss the potential harms and benefits of early detection methods such as the PSA test and then make an informed decision as to whether or not to test.
Men with a family history or black men may wish to discuss starting testing at an earlier age. The Cayman Islands Cancer Society also recommends that men have both a DRE as well as a PSA when undergoing prostate testing.
In summary, the decision to test for prostate cancer is one for each individual man to make with guidance from his doctor.
For more information on breast cancer in men contact the Cayman Islands Cancer Society by calling 949-7618 or emailing [email protected].
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