Should You Get Screened for Prostate Cancer?

In the past, men in their 40’s and 50’s received a simple message from doctors about prostate cancer screening: Get screened! It may save your life.

In recent years, that message has gotten more complicated.

That’s because there’s been a debate among medical professionals about whether the benefits of screening outweigh potential harms.

What potential harms? False positives, unnecessary surgery or radiation, and complications such as erectile dysfunction or urinary problems as a result of treatment.

So, what’s a guy to do?

A Reason to Get Screened

“I believe that screening is beneficial because you can detect prostate cancer before it becomes symptomatic and causes problems,” says John Reilly, MD, who treats men with prostate cancer at UNC REX Cancer Care. “That’s my professional opinion, and my view is biased by the fact that in my practice I see a lot of younger men with aggressive, life-threatening cancers.”

But Dr. Reilly also says not all prostate cancers are the same, and that’s where it gets tricky.

“Some prostate cancers are what we call indolent or slow-growing, and these may never cause the patient to have any noticeable symptoms or need treatment,” Dr. Reilly says.

In fact, about half of men with newly diagnosed prostate cancer are in this category and would be good candidates for active surveillance. Of course, the other half have more aggressive prostate cancers that grow faster, and men do die from this disease as a result.

Potential Harms and Changing Recommendations

Concern about potential harms led the U.S. Preventive Services Task Force—a group of medical experts that assesses screenings—to recommend against prostate cancer screening in 2012. It’s something that has caused a lot of confusion among men and even medical professionals.

“I have worked for years to increase prostate cancer awareness and screenings among African-American men, who are still more likely to get prostate cancer and to die from it than any other group of men,” says Leroy Darkes, MD, a longtime member of the North Carolina Minority Prostate Cancer Awareness Action Team. “From my perspective, that recommendation certainly was not helpful.”

But in 2017, the national task force changed its recommendation. Now it recommends men ages 55 to 69 make an individual decision about prostate cancer screening after talking to a doctor, so each man has an opportunity to understand the potential benefits and harms of screening and to incorporate his values and preferences into his decision.

The takeaway? Ask your doctor if you should get screened.

Similarly, the American Cancer Society recommends that men discuss with their doctors the uncertainties, risks and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information first.

For men who are at average risk, the American Cancer Society recommends having the discussion at age 50.

For men who are at average risk, the American Cancer Society recommends having the discussion at age 50.

Move the talk earlier, to age 45, if you’re African-American or have a first-degree relative (father, brother or son) who was diagnosed with prostate cancer before age 65, because men in this group are at higher risk.

Men at highest risk—those who have more than one first-degree relative who had prostate cancer at an early age—should consult with their doctors at age 40.

“The bottom line is that patients need to talk with their primary care physician and evaluate their risk before making a decision about screening,” says Dr. Reilly.

Screening Not Recommended for Men Older Than 70

Screening for prostate cancer usually includes a digital (finger) rectal exam of the patient by a doctor and a blood test to measure the patient’s level of prostate-specific antigen (PSA), a substance that can be high in men with prostate cancer. (It’s important to note other conditions can cause high PSA, too.)

The American Cancer Society says that men who don’t have symptoms of prostate cancer and have a life expectancy of less than 10 years should not be offered PSA-based screening because they are not likely to benefit. According to the National Center for Health Statistics, the average life expectancy for men in the U.S. is about 76 years. Of course, that can vary.

The U.S. Preventive Services Task Force also recommends against PSA-based screening for prostate cancer in men ages 70 and older. Because many prostate cancers are slow-growing, most men in this age group—even those who have been diagnosed with prostate cancer—are more likely to die from other causes before prostate cancer becomes a problem for them.

If you’re a man between ages 40 and 70, talk to your doctor about the uncertainties, risks and potential benefits of prostate cancer screening. Your doctor can help you make the right decision for you.

Need a doctor? Find one near you or call UNC HealthLink at (984) 974-6302.