Screening is a process to find a disease in people with or without symptoms. Prostate-Specific Antigen (PSA) screening was introduced in the U.S. around 1987. And approved by the FDA as a prostate cancer screening tool around 1994.
The use of PSA testing has increased rapidly in the U.S., resulting in a higher number of prostate cancer diagnoses among men over 50. This prompts us to question whether such extensive prostate cancer screening genuinely improves outcomes or poses potential challenges.
It is widely recognized that prostate cancer is frequently overdiagnosed and overtreated in many Westernized countries. Many doctors who diagnose prostate cancer are urologists with specialized training in surgery, which influences their approach to diagnosis and treatment
Overdiagnosis can sometimes lead to unnecessary medical interventions. It’s important to note that treatments for prostate cancer carry potential risks of serious side effects. Current research suggests that only a small percentage of diagnosed prostate cancer cases may require aggressive treatment.
Small cancerous tumors, localized to the prostate, rarely need treatment beyond that of watchful waiting or active surveillance. A 2016 study concluded that most men with early prostate cancer can safely choose active surveillance. And wait while monitoring their cancer rather than choose surgery, radiation, or other treatment.
Common Screening for prostate cancer
Most prostate cancer is found today via a prostate biopsy originally initiated as the result of a high PSA value. The diagnosis and recommendations that follow often tend to ignore the fact that only about 10 to 15 percent of such cancers might be aggressive and advance beyond the prostate.
Implications
Today, using a PSA test to screen men for prostate cancer has raised considerable controversy. The effectiveness of prostate cancer screening using a PSA test has been a subject of debate, with questions about its ability to save lives versus the potential distress it may cause when symptom-less, indolent prostate lesions are discovered. In some cases, it is clear that the benefits of such screening do not outweigh the risks of follow-up diagnostic tests. In some cases, follow-up diagnostic tests, such as biopsies or subsequent cancer treatments, may be necessary, and it’s important to make informed decisions about these procedures.
Receiving a diagnosis that includes the word ‘cancer’ can understandably be distressing for many men and their loved ones. It often leads to a desire for prompt treatment to prevent any potential spread. However, it’s essential to consider individual circumstances and consult with healthcare professionals to make informed decisions.
The population is well ingrained in this fear. In many cases of slow-growing, indolent prostate cancer, the fear may well turn out to be worse than the disease. And, in cases where patient fear initiates unneeded aggressive treatment, it can result in serious degradation of a man′s quality of life. 1
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Prostate Cancer Screening Recommendations
Prostate cancer screening has gained widespread attention in recent years and has sparked some controversy. Reputable health organizations have issued a range of recommendations for prostate cancer screening, some of which have been widely accepted, while others have generated debate.
American Cancer Society
For instance, the American Cancer Society (ACS) advises that men, in consultation with their healthcare providers, should make informed decisions about prostate cancer screening. According to ACS guidelines, screening typically begins at age 50 for men at average risk and at age 45 for those at high risk of developing prostate cancer.
Prostate Cancer Foundation
On the other hand, the Prostate Cancer Foundation recommends starting at 45 for all non-African American men with no family history and 40 for African American men or those with a family history of prostate cancer.
United States Preventative Services Task Force
And, the United States Preventative Services Task Force (USPSTF) recommends screening for men aged 55 to 69 years without any routine PSA screening for men over 70. Note that these recommendations apply to PSA screening of healthy men without symptoms. All recommend men discuss the potential benefits and harms of screening with their clinician before making a decision.2
Unfortunately, many men may not have a thorough understanding of the advantages and disadvantages of prostate cancer testing. As a result, they often rely on their healthcare providers to guide their decisions. Some urologists carefully assess each patient’s unique condition and work collaboratively with them to determine the most appropriate course of action based on individual circumstances.
Other Recommendations
There are varying opinions regarding whether all cancers should be aggressively treated, and the best course of action may differ based on individual patient factors. The latter approach may be quite contrary to patient expectations as well as patient well-being. This is especially true if the healthcare provider did not accurately warn the patient of possible side effects in advance.
This can lead to confusion for many men who encounter conflicting recommendations from healthcare experts. To resolve this conflict, a man should inform himself of the pros and cons of testing for prostate cancer. As well as subsequent treatments that may be initiated by an out-of-range PSA result.
All treatment for prostate cancer has significant side effects, mostly sexual. Medical personnel often tend to minimize such side effects when they present them to their patients. It’s important for any man considering prostate cancer treatment, especially surgery, to carefully weigh the potential side effects, including impacts on sexual function, and to make an informed decision based on their unique circumstances. 3
Screening for Prostate Cancer
The PSA test is the leading method of screening for prostate cancer. It is a simple blood test in which the PSA level is measured. The PSA test is often combined with a digital rectal exam (DRE). This is done in a physician’s office. A gloved finger is inserted into the rectum to feel and examine the prostate for irregularities.
Screening for prostate cancer is a highly personal decision, and many men trust their doctors to guide them in this process. However, it’s essential to engage in open conversations with your healthcare provider to understand their screening and treatment approaches.
Prostate cancer comes in many different flavors. According to the latest research, most prostate cancers we find today are the result of a small tumor that confines to the prostate gland. Typically, we find this when the result of an out-of-range PSA test leads to a prostate biopsy. This type of cancer, called indolent prostate cancer, is the kind that a man can live with. Sometimes for the rest of his life, without incurring any significant harm from it.
Indolent prostate cancer, a type that can often be non-life-threatening, is frequently discovered incidentally, sometimes during autopsies of individuals who have passed away from unrelated causes.
Harms of Screening
PSA testing itself is non-invasive. But an out-of-range result often initiates a further investigation, such as a prostate biopsy or aggressive treatment.
Approximately 20 percent of prostate biopsies may result in complications, with the most common being infection. It’s important to discuss the risks and benefits with your healthcare provider. Most urologists say that infection is unlikely. But, in order to prevent infection, patients almost always need prophylactic antibiotics.
Studies suggest that the rate of individual complications from prostate biopsies is estimated to be around 14 to 18 percent, primarily due to infection. While rare, some of these infections can be serious.
A biopsy may also find low-risk cancer that might initiate a recommendation for immediate treatment. If someone receives treatment for low-risk cancer, the side effects of the treatment can easily exceed the long-term harmful aspects of the disease.
In some cases, carefully considering the risks and benefits of aggressive cancer screening and treatment may lead to a decision not to pursue immediate treatment. However, this decision should be made after thorough consultation with medical professionals. For instance, side effects of a radical prostatectomy, a surgical procedure that removes the prostate gland and associated structures, can include long-term erectile dysfunction or incontinence. These potential side effects should be discussed with your healthcare provider as they may impact your quality of life.
For a man that has always had an active sexual life, this can be devastating. Aside from sexual effects, many treatments result in either temporary or permanent incontinence. Either of these can have a significant effect on a man′s quality of life.
Discussion
It’s important for each man to talk with his doctor about whether prostate cancer screening is right for him. If you have a prostate cancer diagnosis, the discussion will include your level of risk, overall health, life expectancy, and desire for eventual treatment. It’s important for each man to have an open discussion with his doctor about prostate cancer screening, taking into account his individual risk factors, overall health, life expectancy, and treatment preferences.
Screening isn’t perfect. Our society tends to push screening as the panacea that will positively conclude if cancer is present or not. With prostate cancer, this is a very bad assumption. Screening and biopsies are valuable tools, but they are not foolproof. Sometimes they may miss cancer or lead to further testing or treatment. Testing and screening can indicate that something is suspicious when it is not. This, therefore, opens the door to more testing and/or treatment.
Aside from a biopsy that positively returns a definitive cancer diagnosis, there is no reliable non-aggressive test that can positively identify cancer. In addition, no reliable test can determine if a cancer is seriously aggressive and can become life-threatening. Some cancers grow so slowly that they may never cause a man any problems. Whereas, others can become life-threatening even before patients notice them.
Research studies do not show that regular PSA testing helps men live longer. However, most men that are presented with a prostate cancer diagnosis are inclined to seek immediate treatment. Treatment decisions should be made based on careful consideration of individual circumstances and consultation with medical professionals. While some treatments may have side effects, their impact on life expectancy should be discussed thoroughly with your healthcare provider.
Takeaway
As mentioned above, all treatment for prostate cancer results in side effects. For some men, this may be unimportant. But for others, it can be devastating.
For example, a man with a high degree of sexuality may be deeply disturbed when he learns that his previous ability to perform sexuality has been totally and permanently eliminated for the rest of his life. This is a consideration any man considering prostate cancer treatment should evaluate.
It’s crucial for every man to have access to comprehensive information before considering prostate cancer testing, allowing them to make informed decisions if the test results are positive. Healthcare providers, including urologists, play a vital role in informing patients about potential side effects of treatment. It’s essential for patients to have open discussions with their doctors to understand these risks fully.
Testing really is a decision that a man should make with his doctor. But only once he is aware of all of the potential outcomes. Published age-specific ranges may not fit each individual patient. It is always best to consult with a clinician that is both knowledgeable about the issue and compassionate to your particular circumstance. 4
Our Natural & Non-Invasive Prostate Biopsy Alternative
We offer an alternative to prostate biopsy called the Advanced Prostate Cancer Risk Assessment (APCRA), which includes non-invasive blood tests and specialized color Doppler scans.
The variety and sophistication of some of these new blood tests make this a very realistic alternative to a prostate biopsy, especially if you have a preference for non-invasive diagnostics and treatments.
After this testing, you will receive a thorough, 3-hour consultation from a Naturopathic Physician who is also a Professor of Urology and a very detailed, written report of your results to be discussed during the appointment.
He will walk you through the results of his assessment and explain every aspect and each option available to you, while also answering any questions that you may have. During your consultation, you will receive comprehensive information about your assessment results and available options to help you make an informed decision as a patient.
Most urologists will have a preference for the particular treatment that they provide. However, the consultant you will see has no agenda and is completely free to offer honest, independent advice.
He will try and help with any information you need in order to arrive at your decision. But he will not try to sway you one way or the other.
The APCRA offers advantages such as being non-invasive, causing no damage, and maintaining future treatment options. These benefits are supported by our assessment process.
To book our Advanced Prostate Cancer Risk Assessment please call our customer service team on +1-888-868-3554 who will be happy to assist you and offer any further information.
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