November 6, 2020
Actor Ben Stiller, Pennsylvania Gov. Tom Wolf, and NBC weatherman Al Roker used their prostate cancer diagnoses as an opportunity to highlight the importance of early detection.
Stiller’s prostate cancer was diagnosed as his doctor watched the actor’s PSA (prostate-specific antigen) blood test numbers rise over a year-and-half. The governor said his cancer was found early through a routine checkup.
“Whatever the problem is, regular medical checkups really do matter,” Gov. Wolf said.
Let me say—I concur!
Prostate cancer is the second-most-common cancer in men. While about 1 in 6 American men will be diagnosed with prostate cancer in their lifetime, only about 3 percent will die from it. That is because many prostate cancers are “indolent,” developing very slowly. And when detected early, prostate cancer is a very treatable disease.
Screening for Prostate Cancer
Since early prostate cancers have little or no symptoms, screening tests are needed to find the life-threatening forms at a curable stage. The most notable screening tests are the PSA or prostate-specific antigen blood test and the digital rectal exam.
PSA testing, unfortunately, is imperfect in distinguishing prostate cancers that are life- threatening from the ones that are indolent, or relatively benign. PSA test results lead to many unnecessary further tests, biopsies, surgeries and radiation therapy. This can result in pain, anxiety, incontinence and erectile dysfunction, depending on the type of intervention. Overall, there is a minimal survival benefit.
Weighing The Risks and Benefits
So, weighing the small potential for saving a man’s life against these potential harms, many organizations — including the U.S. Preventive Services Task Force, American College of Physicians, American Urologic Association, the American Cancer Society, and others — recommend informed decision-making about PSA testing between patients and their health-care providers, based on the risks and benefits.
The American Cancer Society guidelines, for example, recommend discussing risks and benefits of screening starting at age 50 for average-risk men, age 45 for high-risk men (African-Americans and those with first-degree relatives diagnosed with prostate cancer before age 65) and age 40 for higher-risk men (those with more than one first-degree relative diagnosed with prostate cancer at a young age).
Given the slowly progressive nature of most prostate cancers, testing is likely to benefit only those with a life expectancy in excess of 10 years.
Low-Risk vs. High-Risk Disease
Once PSA screening is initiated, some men are found to have very low-risk disease. They may opt for active surveillance rather than upfront treatment with surgery or radiation. If worrisome features develop later, surgery and radiation can be implemented then. If such features do not develop, then low-risk men are spared the possible side effects of the therapies.
Other men, found to have high-risk disease, would need appropriate curative therapies promptly to safeguard their lives.
The limitations of PSA testing, however, lead many men in intermediate risk groups to have surgery or radiation when they might not require it, putting themselves at risk of the therapies’ side effects unnecessarily.
For your future health, it is important to discuss with your physician the risks and benefits of prostate cancer screening, based on your personal risk factors, goals and values.