Medical Opinions Differ on Testing for Prostate Cancer

Q:  I have heard a great deal about the prevention and early identification of prostate cancer lately, and frankly I'm confused. Can you shed some light on what the most reasonable approach might be for a man contemplating his future?

A:  You are probably confused because those of us in the medical profession have differing opinions about how to use current technology to the best advantage.

By way of background, the prostate gland's main purpose is the secretion of the fluid that is used to propel sperm during ejaculation. Part of the prostate gland can be felt during a rectal exam.

The prostate gland is prone to the development of cancer. Autopsy studies in men who died of other diseases have found that as many as 70% had some evidence of prostate cancer.

The prostate gland can also increase in size with aging (benign prostatic hypertrophy or BPH). The fact that it has a capsule or outer sheath that doesn't expand much and that the urethra runs through it and is compressible can make urination difficult.

Prostate specific antigen (PSA) testing is a screening test for the presence of cancer. This test led to the highly publicized diagnoses of cancer in Bob Dole and Rudy Giuliani.

The problem with PSA testing is that it does not tell you how much cancer you have. Most men with a positive test will need additional testing such as an ultrasound of the prostate and a biopsy (the removal of several small pieces of the gland). The result of the testing may lead to the early detection of a significant prostate cancer or the identification of a few renegade cells that pose no immediate threat.

As a family doctor, I recommend prostate cancer screening in men without symptoms who have a positive family history of prostate cancer or symptoms of partial obstruction. This differs from the recommendations of most urologists (all men over 50 and beginning at 40 for those at high risk) but is consistent with the recommendations of the US Preventive Services Task Force.

Ultimately, each man has to decide for himself whether he wants the test. More important is the need for regular health care maintenance visits for men beginning at age 40 or sooner if you have a chronic condition such as high blood pressure or diabetes.

"Your Health" provides easy-to-understand information about common health conditions.