Who should undergo screening for prostate cancer? Are there any risks?
The prostate is a male reproductive gland that produces seminal fluid to nourish and transport sperm. Prostate cancer may not show symptoms in its early stages, but more advanced stages may cause symptoms such as trouble urinating, decreased force in the urine stream, blood in urine, blood in semen, and unexplained weight loss.
Who should undergo routine prostate cancer screening? According to the American Cancer Society, the following three groups of men should consider prostate cancer screening:
- Men aged 50 years old with an average risk of prostate cancer and a life expectancy of at least another 10 years. Why is a life expectancy of 10 years or more specified? This is because prostate cancer is typically slow-growing. Survival rates are not significantly impacted within the first 10 years after diagnosis. In other words, if an older adult with a life expectancy of less than 10 years is diagnosed with prostate cancer, the cancer is unlikely to have much impact on them.
- Men aged 45 years old with a high risk of prostate cancer, including African Americans, and those with a father or brother diagnosed with prostate cancer before age 65.
- Men aged 40 years old with a very high risk of prostate cancer, such as those with more than one father or brother diagnosed with prostate cancer before the age of 65. Prostate cancer appears to run in some families, indicating the presence of genetic or inherited factors in some instances. For those with a father or brother who has had prostate cancer, the risk of developing the disease is more than doubled.
Is Routine Prostate Cancer Screening Necessary?
I have a friend in his 80s who was in good health. However, after screening and undergoing prostate surgery, he now experiences difficulty urinating and needs to self-catheterize each time.
For the general population, routine screening for prostate cancer may not be necessary. This is mainly due to the following three factors:
- Prostate cancer progresses slowly and often does not cause health problems or symptoms in many patients.
- Modern medical tests can result in false positives and false negatives. For example, in prostate-specific antigen (PSA) testing, if the test value falls within the normal range, there is still a 25 percent chance of having prostate cancer. If the value is above the normal range, the likelihood of having prostate cancer exceeds 50 percent. In other words, a significant number of people may receive false positive results, while others may test negative despite having prostate cancer, which is a false negative. Therefore, relying on PSA testing for diagnosis in these cases can lead to overdiagnosis. Prostate biopsies can also result in false positives and false negatives. This is because the testing process does not always guarantee detection of the cancerous area.
- Aggressive treatment may not always be the best approach. There are various treatment options for prostate cancer, including medication, surgery, and radiation therapy. However, these treatments can have side effects such as urinary incontinence, erectile dysfunction, and bowel dysfunction.
Therefore, screening, diagnosis, and treatment for prostate cancer should be approached with great caution.
Case Analysis of the US Defense Secretary
U.S. Defense Secretary Lloyd Austin’s recent hospitalization after spotting prostate cancer during screening has garnered a fair amount of attention.
At the age of 70, Mr. Austin was diagnosed with prostate cancer during a routine screening. He underwent prostate cancer surgery on Dec. 22, 2023. Due to complications after the surgery, he was admitted to the intensive care unit in January 2024. Two weeks later, Mr. Austin was discharged and began working from home. He returned to the Pentagon on Feb. 15.
Currently, the necessity of prostate cancer screening mainly depends on individual factors and choices. So why did Mr. Austin choose to undergo routine screening? Several factors may have influenced this decision:
- Age: Prostate cancer is rare in men under 40, but the risk increases rapidly after age 50, with approximately 60 percent of prostate cancer patients being over 65 years old.
- Race: Black men of African or Caribbean ancestry have a risk of developing prostate cancer about twice as high as that of non-black men. Black men are also more likely to develop rapidly growing and spreading prostate tumors, and they have a higher risk of dying from prostate cancer than other men.
- Family history: If Mr. Austin has a family history of prostate cancer, routine screening was the right choice for him.
Prostate cancer is a private matter for men, particularly since it can affect sexual function, which can impact patients psychologically. I hope this article provides valuable information on prostate health and helps those in need make informed decisions.
