Why is there no prostate cancer screening?
- The incidence of prostate cancer is increasing in western societies, and many men continue to die of the disease.
- The only way currently to cure the disease completely is to remove the prostate while the cancer is still confined and has not spread.
- PSA is prostate-specific, but not cancer-specific. This means that a raised PSA always points to a problem of some kind with the prostate, but it does NOT necessarily mean that the problem is cancer – it could be infection of the prostate or simple benign enlargement. It was originally thought that tumours detected by PSA testing might prove to be relatively innocuous – the kind that might progress only very slowly and not cause symptoms during a man's natural lifespan. Most scientists now believe that tumours detected by PSA are significant and require treatment.
- The evidence that screening (testing normal men who don't have any symptoms at all) reduces the death rate from prostate cancer is fairly scant at present – however most urologists think that over the next few years it will be shown that screening is effective.
- Screening can be a cause of significant problems.
- The prostate biopsy is associated with a complication rate of up to 2% (usually persistent bleeding, difficulty passing water, or infection).
- A negative biopsy does NOT exclude a cancer – therefore the man is left in an anxious situation, not knowing whether he has cancer. The normal procedure is to continue to follow the situation with repeat PSA testing and further biopsies if necessary.
- One of the arguments against screening is that it may detect cancers which are not confined to the prostate and are thus incurable anyway. Furthermore, some cancers detected by screening will not give rise to any symptoms during the man's lifetime – the problem is that scientists don't know which ones will and which won't.
- Screening is expensive and would add a further burden to the NHS.
As with all complicated decisions the best course of action is to be fully educated and then make up your own mind.
Getting a PSA test
- If you are over 50 and persistent your GP may test you, especially if there is a family history of prostate cancer.
- Pay to go privately. Look for private health clinics and hospitals offering Well Man or similar health screening services.
Page created on February 28th, 2010
Page updated on March 10th, 2010