To Screen or Not to Screen (For Prostate Cancer): The Troubling Question for Men

The American Cancer Society estimates that roughly 35,000 cases of prostate cancer are expected to occur among African-American men this year and that 1 in 5 African-American men will be diagnosed with prostate cancer in their lifetime. Given the scope of this problem, it's no wonder that many African-American men are wondering what they should do about getting an annual PSA test now that the U.S. Preventive Services Task Force# (USPSTF) is recommending against using prostate-specific antigen (PSA)-based screening for prostate cancer and has given it a "D" rating. The definition of the "D" rating is that the USPSTF recommends against the service and that there is moderate to high certainty that the service has no net benefit or that the potential harm outweighs the benefits.#

To understand the recommendations from the Task Force, I interviewed Dr. Otis Brawley -- Chief Medical and Scientific Officer for the American Cancer Society. Dr. Brawley talked about the data with respect to lives saved from PSA testing, the problems associated with following up PSA test results, and the conversation that men should be having with their doctor about getting an annual PSA test. You can listen to my interview with Dr. Brawley at

For men who don't have symptoms of prostate cancer and are now asking if they should get the PSA test as part of their routine medical check-ups, there is still no consensus within the medical community. Moreover, even when a man has a PSA test that results in prostate cancer being detected, physicians can't accurately predict which prostate cancers will be aggressive from those that will grow so slowly that the patient will likely die from some other health condition long before their prostate cancer becomes a serious threat to their life. Absent the ability to make the distinction between the aggressive versus the slow growing cancer, many men opt for treatment -- which can have serious side effects such as incontinence and erectile dysfunction.

For years, consumers have been told that their best chance for becoming a cancer survivor is to find the cancer early and treat it. The Task Force's recommendation turns this mantra on its head and will cause men to seriously think about the conversation that they'll need to have with their doctors around this issue. There are many men whose cancers were identified as a result of a PSA test who feel that early detection and treatment of their prostate cancer saved their lives. They are comfortable with their decision. However, in light of this new recommendation by the USPSTF, men should take it upon themselves to be informed of all of the ramifications of getting a PSA test before agreeing to have the test done. Ultimately, some men will choose to get the test because they want to know if they are walking around with a potential problem. Others may choose not to get the test on a routine basis and to be tested only if they have symptoms. Still others may choose to have the test done routinely simply for peace of mind -- to be reassured that they don't have a PSA level that suggests that they may have prostate cancer. Whatever their decision, it's important to remember that men deserve to be informed of all of the facts, pros and cons, and controversies and be given time to understand and evaluate the information without being pressured into a specific course of action.

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