Prostate cancer screening has been a mixed bag over the past several decades. In the late 1970s and early 1980s, we were excited to find a marker in the blood specific to the prostate known as PSA – prostate-specific antigen. This was a watershed moment in the diagnosis and, ultimately, treatment of prostate cancer, but not in the way we all thought back then. Without the benefit of hindsight, the initial reaction to PSA was to set a cutoff (of about 4), at which point a prostate biopsy would be ordered.
Now, looking back, we knew very little about prostate cancer and compounded the PSA oversight by treating virtually every case with little regard for stratifying risk. As such, many with a PSA above four or so were biopsied, and anyone who came back positive for prostate cancer typically underwent a prostatectomy or radiation, both of which can have significant consequences in the short- and long-term, including urinary incontinence and erectile dysfunction. This is not to mention the anxiety that accompanies being told you have cancer that requires surgery. The result was a snap-back overreaction, where PSA was summarily marginalized.
Yet, one of the holdovers of this roller coaster is the fact that there genuinely are no singular guidelines or recommendations for when to get screened or even to get screened at all. Yes, several organizations have rolled out best practices, but they ultimately leave the choice as to whether to get screened up to the patient and their doctor. Frankly, this is the ideal situation. However, it has also created a lack of awareness that results in many patients not scheduling a prostate cancer screening when they would benefit. Oh, and it’s far more accessible and less invasive than, for example, a colonoscopy, which we all know to get when that time comes.
Why You Should Get Tested
Prostate cancer is one of the most common cancers in the United States, and it is also one of the most treatable in its earliest stages. Statistically, almost 100% of patients with localized prostate cancer survive five years. When the cancer becomes distant – and spreads into other organs – this survival rate drops by over half. This, therefore, shows that catching prostate cancer early is very important.
Some clinicians believe that standardizing a prostate cancer exam may be detrimental to the mental and physical health of the patient. Why? As good as PSA and digital rectal exams are, they do sometimes produce false positives that lead to biopsy and a great deal of anxiety. Remember that most prostate cancers (over 90%) are low-grade, and many do not need to be treated. This gave rise to the famous quote that most men diagnosed “will die with prostate cancer rather than from it.”
That said, with a proper consultation before testing, Dr. Kapadia tries to put men’s minds at ease. He discusses the PSA and tests to see if a concerning trend emerges. Even if the biopsy shows prostate cancer, this does not mean that it is aggressive and may not even require any treatment, but just active surveillance to ensure it doesn’t get any worse. Of course, patients may have to come to terms with the fact that they have cancer cells in their bodies, but understanding prostate cancer patterns can help allay their fears.
A More Aggressive Diagnosis
If patients are given the diagnosis of an aggressive form of prostate cancer, there is, of course, that very justified sense of dread. Even here, it’s important to remember that by getting screened, you found it earlier than you otherwise would have and, therefore, may have more treatment opportunities with potentially better outcomes. Today, we have more advanced prostate cancer therapies than ever before, including surgery, radiation, ablation of cancer cells, and even immunotherapies. While the gold standards remain radiation and prostatectomy for high-grade cancer, we also know far more about optimizing recovery after either or both procedures. Indeed, Dr. Kapadia has dedicated part of his practice to comprehensively treating the concerns associated with urinary incontinence and erectile dysfunction that invariably follow, albeit often temporarily, radical prostatectomy and/or radiation.
The Bottom Line
Ultimately, the decision to get screened is yours, but it’s worth considering talking to a urologist about prostate cancer screening as early as age 40. That said, we are here to work through any questions or concerns you may have about prostate cancer and walk you through a diagnosis, whether low-grade or high-grade, to ensure you receive the very best outcomes with the fewest potential adverse effects.