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.
Testing caught on rapidly in the U.S., and the number of men over 50 diagnosed with prostate cancer has skyrocketed since. This begs the question of whether or not such intense screening for prostate cancer actually saves lives or causes more problems.
It is well-known that prostate cancer is substantially overdiagnosed and overtreated in most Westernized countries. Most doctors that diagnose prostate cancer are urologists with surgical urological training. Thus, diagnosing and treating prostate cancer is a significant part of their practice.
Overdiagnosis usually leads to medical treatment. Every treatment used today for prostate cancer carries with it the risk of serious, unwanted side effects. According to the latest research, only a small percentage of diagnosed prostate cancer actually needs 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.
Today, using a PSA test to screen men for prostate cancer has raised considerable controversy. It is questionable if this type of screening actually saves lives or simply permits more distress for patients that have had a symptom-less, indolent prostate lesion discovered. In some cases, it is clear that the benefits of such screening do not outweigh the risks of follow-up diagnostic tests. Such as a biopsy or subsequent cancer treatments.
Unfortunately, for many men and their spouses, any diagnosis mentioning the word cancer is serious. It causes great distress, and often results in an immediate desire to treat it before it spreads.
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
In the recent past, screening for prostate cancer has become ubiquitous as well as somewhat controversial. Reputable health organizations have provided varying recommendations for screening that have, in some cases, been tentatively accepted, and in others, roundly discouraged.
American Cancer Society
For example, the American Cancer Society (ACS) recommends each man, along with his medical care provider, should make his own decision regarding screening. According to the ACS, screening should start at 50 for men at average risk and 45 for men 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, it is a rare man that is well-versed in the pros and cons of such testing. Most men opt out of the decision-making process and defer to their clinician to make their decision for them. Some urologists evaluate each patient′s condition carefully and recommend the best course of action based on the specific patient and conditions.
Others believe that we should find and treat all cancers. Whether or not this is really in the patient′s best interests. 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 leaves many men trying to negotiate a minefield of conflicting recommendations from 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. Any man that values his sexual abilities should think hard and twice about submitting to any treatment for prostate cancer, especially surgery. 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 an extremely personal and complex decision. Many men leave the decision to their doctor. However, unless you are personally familiar with both your doctor′s screening and treating philosophies, that is not always a viable path to take.
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.
It is also the type of cancer we find most often after an autopsy on men that have died from other 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 biopsies result in complications. The most common complication being infection. Most urologists say that infection is unlikely. But, in order to prevent infection, patients almost always need prophylactic antibiotics.
Studies show that the rate of individual complications from a biopsy is about 14 to 18 percent. This is mostly due to infection. A small percentage of such infections can be life-threatening.
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.
Sometimes, it is better to not treat your cancer than suffer the side effects of aggressive screening and treatment. For example, side effects of a radical prostatectomy, where a doctor surgically removes the prostate gland and associated structures, typically result in lifetime erectile dysfunction or incontinence.
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.
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. If your doctor will not contribute to this conversation, it is time to find a new doctor that will.
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. Sometimes screening misses cancer. Even a biopsy can miss cancer. 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. The treatment itself can definitely introduce conditions that reduce their life expectancy.
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.
No man should entertain testing unless he has all the information to make a critical decision if the testing returns a positive result. Medical doctors, particularly urologists, are often in denial about the potential for permanent side effects of their treatment.
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
In our opinion, a far safer and gentler prostate biopsy alternative is our Advanced Prostate Cancer Risk Assessment (APCRA). This consists of 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. Your consultation will be like an educational mini-seminar about the real issues facing you 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.
Aside from that, the greatest additional benefits of the APCRA are that it is non-invasive, does no damage, and does not close off any avenues for future treatment.
Find out 5 Alternatives To A Prostate Biopsy.