Prostate Cancer: To Screen or Not to Screen

CCNM_ICC_13Sept18_150There’s much debate and confusion about screening for prostate cancer and so in honour of Movember and men’s health awareness, we want to discuss the current recommendations.

Here’s what the experts have concluded:

Despite what you may remember about PSA testing and DREs (digital rectal exam), the above organizations have made it clear that prostate cancer screening is not necessary for every man.

Why has the research come to this conclusion?

  • Over diagnosis – PSA screening could lead to an over diagnosis percentage as high as 40-55%. Over diagnosis is when cancer is found however, if it was not found, would not cause symptoms or death. These patients will be treated unnecessarily.
  • False positive results – this occurs when a positive PSA test results in additional tests (e.g. a biopsy) that doesn’t end up finding cancer. The rate of false-positive results varies but could be between 11-20% of all screened men. Factors that can increase the risk of a false-positive PSA test result are urinary tract infection and benign prostatic hypertrophy (BPH), to name a few.
  • Harms of PSA screening – this relates to both investigating and treating prostate cancer in men who either do not have cancer (false positive result) or their cancer would not cause them any symptoms or death (over diagnosis). The harms include: urinary incontinence, infections, additional surgeries, hospital admissions, blood transfusions, long-term erectile dysfunction and death.

What does this mean for you?

  • All of the above organizations discuss shared decision making starting at about age 40 when thinking about screening for prostate cancer.
  • Shared decision making occurs between you and your primary care doctor where you discuss the benefits and risks of screening for you. This would consider your individual risk factors, family history and race.

Prostate cancer is the most commonly diagnosed non–skin cancer in men and the third leading cause of cancer-related death among men in Canada. If you are high-risk for prostate cancer, consider booking an appointment at the CCNM Integrative Cancer Centre, where we work to reduce your risk through diet, lifestyle as well as certain herbs and supplements. There’s no absolute prostate cancer prevention however evidence suggests you can make a difference in those modifiable risk factors.