Screening FAQ

Mpower Prostate Cancer Registry

Screening FAQ

The information provided here is general in nature and should not be construed to be medical advice for specific health conditions or a substitute for professional medical care. If you have, or suspect you may have, a health problem, you should consult a licensed health care provider.

Ruth Etzioni, PhD

Dr. Etzioni’s group focuses on innovative statistical and computer modeling to project and better understand of cancer progression.

Should I be screened for prostate cancer? If so, how often?

There is no single answer to this question. Without screening, a man’s chance of dying of prostate cancer in his lifetime is approximately 3 percent. With screening, based on the most optimistic interpretation of the available data, this risk goes down to about 2.2 to 2.4 percent. Because of the controversy about prostate cancer screening, men often think that prostate cancer is more of a threat to their health than it actually is. Man should consider their risk of prostate cancer death in the context of their general health. If their objective is to improve their health and lengthen their lives there will likely be many other things that they can do that will have known benefits, like exercise, improving diet, and reducing stress. If men decide to have a prostate cancer screening test then they should understand that the test may detect a cancer that does not need to be treated. Men should not be tested if they are unwilling to consider not being treated should they be diagnosed with a low-risk lesion. Regarding the best interval for testing, it seems clear that men can be tested every couple of years or every few years and they will benefit almost as much as being tested every year (but will be more likely to suffer the harms of screening).

What are the various prostate cancer screening options?

Currently, PSA testing is the primary option. Digital rectal exam is also used, but PSA is really the main test.

What should I do if prostate cancer is found?

Don’t panic. Learn about whether your cancer is low or high risk. Consider your age and your general health. If you have other health conditions like hypertension or a history of cardiac disease and you have a low risk prostate cancer, you may want to focus on these other conditions and improving them rather than worrying about your prostate cancer because if it is low risk then it is unlikely to threaten your life expectancy.

What is watchful waiting and active surveillance?

Is this a good option for me? Watchful waiting is a very low-intensity monitoring program which consists of doctor visits and PSA testing to make sure that your cancer is not progressing. Active surveillance is similar but includes regular biopsies of your prostate to obtain more information on the state of your cancer. I either case, if there is a change that suggests your cancer is growing or getting more aggressive, you will be offered the option of treatment. Our research indicates that in the case of low-risk tumors the resulting delay in receipt of treatment has a very minor effect on the chance that you will die of prostate cancer which is extremely low anyway.

What are the benefits of PSA screening?  What are the potential harms?

In certain cases, PSA screening can enable prostate cancer to be diagnosed earlier thereby permitting curative treatment to be administered. In these cases it is likely that PSA screening saves lives. But even according to the most optimistic interpretation of the data, these cases will only consist of 6 to 8 men per 1000 men screened. The harm of most concern is that the test will detect an inconsequential cancer, leading to unnecessary treatment with all its costs and side effects. Prostate cancer treatment can lead to incontinence, impotence and bowel problems so it is not something to be taken lightly!  A prostate cancer case will always find a doctor willing to treat him but this does not mean that the treatment is going to be beneficial or even that it is needed. Our research suggests that of every 1000 men screened, about 30 to 40 will have an inconsequential cancer diagnosed. Even more will have a false positive test, which is an elevated PSA that is followed by a negative biopsy. Therefore screening has harms as well as potential benefits.

What about the U.S. Preventive Services Task Force screening recommendations?

The USPSTF recommendations were based on a very pessimistic view of the available data including considering the results of the US prostate cancer screening trial as validly representing the benefits of screening versus no screening. It is clear from extended follow-up of the European trial and from USA population mortality trends that PSA screening does save lives.  We feel that continuing to offer PSA screening in ways that reduce harms and encouraging men detected with low-risk disease to manage their diagnosis conservatively should help to preserve the benefits while reducing the costs. But this requires men to recognize that most prostate cancers are not fatal and that the risk of prostate cancer death without screening is low and to make a properly informed decision about how best to manage their prostate cancer risk in the context of their general health.