prostate cancer screening guidelines

Know your risk, and learn what your screening and treatment options are.

The new guidelines stress that men need to know their individual risk of prostate cancer.

RODALE NEWS, EMMAUS, PA—With most cancers, the key to improving your survival rate is early detection. For prostate cancer, early detection is also vital, but the screening and treatment options for prostate are unusually rife with pitfalls. “The risk of what we call ‘overdiagnosis’ and ‘overtreatment’—that is, finding and treating prostate cancers that were never going to harm the patient in his lifetime—appear to be greater for prostate cancer than for any other cancer,” says Andrew Wolf, MD, associate professor of medicine at the University of Virginia School of Medicine and lead author of the American Cancer Society's new prostate cancer screening guidelines. The at-times inconclusive screening results, plus risky treatments for tumors that might not be a threat, are what prompted cancer experts to update the guidelines. The new emphasis: Men would be wise to talk to their doctors about the pros and cons of screening and treatment before deciding on either.

THE DETAILS: Prostate cancer is the second most common cancer in men after lung cancer, and it kills 234,000 men worldwide each year. The two main tests for detecting it are the prostate-specific antigen (PSA) blood test and the digital rectal exam (DRE). Doctors have been recommending the PSA as the gold standard test for years, and the new screening guidelines give it even more prominence over the DRE. However, both methods have drawbacks. For example, even if these screenings detect cancer, they often can’t detect how dangerous it is. Some prostate cancers grow very slowly, while others are more aggressive. Neither test is very good at determining that.

But the bigger issue may be treatment. “If [treating] it was completely benign, I think most men would say ‘let’s screen for it, then treat it,’” says Dr. Wolf. “But surgery and radiation, which are the two treatment options at this point, often lead to problems, including erectile dysfunction (ED), urinary leakage, and bowel injury in the case of radiation.”

Read on for a summary of the new guidelines for prostate cancer screening.