Much attention is given to women’s health, and rightly so. Pap smears, mammograms, menopause…there are many factors to consider in the care of women. During my training, I had a (male) friend who felt somewhat slighted by all this attention given to women, so he was going to arrange a men’s health training program. Undoubtedly, one of the main topics he would have needed to incorporate into his program would be prostate cancer screening. I’m not looking to ignite any ‘battle of the genders’ debates, but as September is prostate cancer awareness month, I thought we could discuss this somewhat controversial topic.
The prostate gland is found only in men, between the bladder and the rectum. It produces fluid that helps transport sperm. In screening for prostate cancer, we aim to detect cancer of this gland before any symptoms begin.
There are certain risk factors that increase the chance of developing prostate cancer. As we age, our risk goes up; prostate cancer is rarely found in men younger than 50 years old. African-American men are at higher risk, as are those with a family history of either prostate cancer or the breast cancer gene (BRCA). Additionally, there are some studies that suggest a diet high in animal fat and low in vegetables may increase risk.
The main method of screening for prostate cancer involves a blood test called the prostate specific antigen (PSA). This is a protein produced by the prostate. When prostate cancer is present, the PSA is usually elevated. However, there are other causes of an elevated PSA, such as benign prostatic hypertrophy (BPH), infections, trauma such as bicycle riding, and sexual activity. It is best to avoid cycling and ejaculation for the 2-3 days prior to testing.
As I mentioned previously, there is some controversy regarding prostate cancer screening. A large European study showed that men who had PSA testing had a 20% lower chance of dying from prostate cancer after nine years compared to those who did not. However, that same study showed that only one in every 1400 men benefited from PSA testing, and 75% of men with an abnormal PSA who underwent prostate biopsy did not have prostate cancer.
Those who have aggressive forms of prostate cancer do have higher cure rates if it is detected early via PSA testing. The five-year survival rate for cancer isolated to the prostate gland is near 100%, while this drops to 30% for cancer that has spread elsewhere. But, a large American study found that PSA testing did not reduce the overall risk of dying from prostate cancer. It is unclear if all detected prostate cancers need to be treated, as the side effects of treatment can sometimes cause more disability than the disease itself.
For these reasons, it is a good idea to discuss prostate cancer screening with your healthcare provider. If a decision is made to screen, this usually begins at age 50 for most men, earlier if there is increased risk as discussed above. Screening is usually done every 2-4 years until age 75.
So as you can see, this is another classic ‘gray area’ of medicine, which is why it is important to discuss further with your primary care provider…but we can leave the ‘battle of the genders’ debate for home!
Dr. Aaron Douglas
Family Practice