Prostate Cancer Screening: Is It Right For You?
No test is right all the time, and that is true of the PSA test and DRE. The PSA test is better at suggesting that small cancers are present, especially those toward the front or sides of the prostate gland or deep within it. But the DRE can sometimes help suggest cancers in men with normal PSA levels. That is why both the PSA test and the DRE are usually performed.
If 100 men over age 50 take the PSA test:
- Eighty-five will have a normal PSA (though a small number of these men will have a cancer that was missed by the PSA test)
- Fifteen will have a higher-than-normal PSA and require further tests.
After further testing, results will show:
- Twelve do not have prostate cancer
- Three have prostate cancer.
Medical experts agree that every man needs balanced information on the pros and cons of prostate cancer screening to help him make an informed decision. Balanced information is important, because medical experts disagree about whether men should be screened regularly for prostate cancer.
Medical experts who encourage regular screening believe that current scientific evidence shows that finding and treating prostate cancer early -- when treatment might be more effective -- may save lives. They recommend that all men who have a life expectancy of at least an additional 10 years should be offered the PSA test and DRE annually, beginning at age 50. They also recommend offering screening tests earlier to African-American men and to men who have a father or brother with prostate cancer.
Medical experts who do not recommend regular screening want convincing evidence that finding early-stage prostate cancer, and treating it, saves lives. They believe some of these cancers may never affect a man's health and treating them could cause temporary or long-lasting side effects, like impotence (inability to keep an erection) and incontinence (inability to control the urine flow, resulting in leakage or dribbling). Because they believe it is unclear if the potential benefits of screening outweigh the known side effects of treatment, they recommend that all men be given information on the pros and cons of screening before making their decision.