When to test for prostate cancer: Finding a balance
A conversation with Fritz H. Schröder, M.D., the principal investigator of the European Randomized Study of Screening for Prostate Cancer
The word "cancer" inevitably draws a quick reaction from patients. Conventional wisdom tells us to rid the body of these rogue cells at any cost. Yet, in the case of prostate cancer, this logic is called into question. Many men who have prostate cancer and either never learn they have it or choose not to treat it often live long lives, eventually dying of something else. Recently, the U.S. Preventive Services Task Force began recommending that men ages 75 or older forgo prostate cancer screening, noting that the potential harm of treating screen-detected cancer may outweigh the benefits in this age group. That's because many screen-detected cancers can take a decade or longer to cause symptoms. But the treatment complications, which often include erectile dysfunction and urinary incontinence, are immediate and can have a negative impact on a man's quality of life.
The attempt to balance quality of life with the benefits of early detection has led to an ongoing debate about when to screen — in particular, whether or not all men should be screened beginning at age 50. On the one hand, screening has been shown to identify potentially lethal cancers at an early and curable stage. One study estimates that one in seven men with screen-detected prostate cancer might be at risk of dying of the disease. On the other hand, current screening and biopsy regimens do not adequately differentiate aggressive cancers from slow-growing ones. It's estimated that more than 50% of prostate cancers diagnosed during population-based screening are indolent, meaning they would not affect a man during his natural lifetime. (See "Population-based screening defined.")