The Pros and Cons of Prostate Screenings

What is prostate cancer screening?
A prostate cancer screening is a test that your doctor uses to look for prostate cancer before you have any symptoms. The 2 types of prostate cancer screening tests are the digital rectal exam (DRE) and the prostate-specific antigen (PSA) test.

Should I be screened for prostate cancer?
The U.S. Preventive Services Task Force and the American Academy of Family Physicians recommend against routine prostate cancer screening for all men, regardless of age.  Based on evidence from research studies, prostate cancer screening — and especially the PSA test — may cause more harm than good for most men. Learn more about the PSA test and the pros and cons of this test below.

What is the PSA test?
The PSA test is a blood test that measures the level of prostate-specific antigen (PSA) in your bloodstream. PSA is a substance produced by the prostate gland. A small amount of PSA usually is found in the blood. But because cancer cells produce more PSA than normal cells, men who have prostate cancer may have a higher level of PSA in their blood. A PSA level can also be high because of less serious causes, such as infection or prostate enlargement.

What are the pros of PSA testing?
The main goal of the PSA test is to find prostate cancer early. For people who have fast-growing (aggressive) tumors, early detection could be very helpful (if the cancer has not spread outside of the prostate at the time it is detected). Cancer is usually easier to treat and is more likely to be cured if it is caught early. However, most men who have prostate cancer do not have the fast-growing, aggressive form of prostate cancer that might benefit from being found early.

What are the cons of prostate cancer screening?
Most men who have prostate cancer have a slow-growing form of cancer. This means that they probably do not have symptoms and may not ever need treatment. However, 90% of men who learn that they have cancer through screening go on to receive treatment anyway. Many experience long-term side effects of treatment, such as urinary incontinence and erectile dysfunction, or have serious complications. Out of every 1,000 men who receive surgery, up to 5 will die from complications of surgery.  In addition, PSA test results aren’t always accurate. Studies suggest that up to 80% of PSA test results are false-positives. This means that the PSA test result suggests that you might have cancer when in fact you do not. A false-positive test result can lead to unnecessary tests (such as a biopsy) and side effects from testing, and may cause worry for you and your family.  For these reasons, some medical organizations, including the U.S. Preventive Services Task Force and the American Academy of Family Physicians, recommend against routine PSA testing for men of all ages.

How do I make a decision?
Ultimately, the choice is yours. If you’re thinking about being screened for prostate cancer, talk to your doctor. Consider the pros and cons of screening, your health and individual risk factors, your preferences regarding diagnosis and treatment, and your doctor’s opinion and advice.