Prostate cancer affects one in 11 men and is a leading cause of cancer death in men - second only to lung cancer. The problem is clear. What's not so clear, however, is what men should do about it.
In the past 30 years, early detection of prostate cancer has not reduced the death rate. Moreover, treatments for the disease carry significant risks.
Most physicians recommend that their patients have annual digital rectal exams after age 50. Some physicians also recommend that their patients take a PSA (prostate-specific antigen) blood test to detect early prostate cancers.
While PSA screening is worth considering, men should be aware that the test remains controversial. The American Cancer Society recommends PSA screening only for men between ages 50-70, while the National Cancer Institute and the U.S. Preventive Services Task Force don't recommend it at all.
Because studies show that PSA protein levels may be higher in men with prostate cancer, the PSA test was designed to measure the level of proteins produced by a man's prostate. However, the test misses prostate cancer up to 30 percent of the time.
In addition, a man's PSA level can be abnormally elevated or "positive" even if he doesn't have prostate cancer. Of all men with abnormal PSA's, only 25 to 30 percent have prostate cancer. The other 70 to 75 percent undergo further testing to find they have normal prostate glands.
When PSA screening detects cancer, it cannot distinguish between prostate cancers likely to spread and endanger a man's health vs. "innocent" or silent prostate cancers that grow slowly.
Innocent prostate cancers can be present for many years without spreading to other areas of the body. They do not affect a man's health or shorten his life. Studies suggest many prostate cancers found in PSA screenings fall into this category.
If a man chooses to have a PSA test and the result is abnormal, his doctor may recommend additional tests to establish the presence or absence of prostate cancer. The PSA test may be repeated - if it is mildly elevated at a stable level over a period of months or years it is less likely to mean cancer.
Your physician may also choose to check PSA test results with an ultrasound. This test uses sound waves to generate pictures of the prostate gland and show areas with a different appearance than the normal prostate gland texture, indicating possible cancer. The definitive test for prostate cancer is a biopsy or obtaining a sample of prostate tissue for analysis.
If prostate cancer is found, there are several options, including "watchful waiting," radiation treatment of the prostate gland, surgical removal of the prostate gland or hormonal therapy. However, some of these procedures carry significant risks, including death or the inability to have sex or control the bladder.
While there is no right or wrong about PSA screening, a man should gather information and make an informed decision about what is right for him. The physician should provide information, answer questions and support the patient in his decision.
Dr. Arthur Liu is a family practitioner at the Palo Alto Medical Foundation's Los Altos Center, located at 370 Distel Circle.