Movember spotlight: The pros and cons of PSA screening for prostate cancer

November 1st marked the beginning of “Movember”! Since 2003, people have been encouraged to celebrate Movember by growing a mustache (or donning a fake one) and raising awareness for men’s health. Why focus on men’s health? On average, men have a shorter lifespan than women (almost five years less), which is partly because men are less likely to visit a doctor regularly. November, or Movember, is a valuable time to reflect on some of the major health issues affecting this population.

One of those health issues is prostate cancer. Prostate cancer is the most common non-skin cancer in men, and it is estimated that over 190,000 men will be diagnosed with prostate cancer in 2020. Despite the fact that prostate cancer is so widespread, and despite the fact that there is a simple blood test that can successfully identify prostate cancer early (called Prostate Specific Antigen, or PSA), there remains significant controversy around the decision to get the test even if men go see their physician and proactively ask about it.

The good news about prostate cancer screening with a PSA test is that it is an easy, non-invasive blood test that can be performed in your doctor’s office. And unlike tests to screen for colon or breast cancer, there is no preparation, fasting or invasive procedures required. However, the PSA test is not very accurate, and the test can cause more harm than good, often alerting doctors to the presence of cancer without knowing if the cancer detected would ever cause symptoms or harm.

That is why checking a PSA test should only be done after a conversation with your health care provider. There are a few reasons for this says Douglas Sutherland, MD, Tacoma-based prostate cancer specialist for MultiCare. “Most importantly, not all men benefit from being diagnosed with prostate cancer,” says Dr. Sutherland. “The disease often requires 10 to 15 years to cause harm or death, so very elderly men and men with serious medical problems should think twice about getting a PSA test.”

Since a man’s primary care provider most commonly understands the overall health of each man, it is ideal for men to get their primary care provider’s opinion about the value of a PSA in their specific case. “Unfortunately, the PSA test is not perfect and is commonly abnormal even when cancer is not present,” says Dr. Sutherland. The PSA test is like the weather channel; the test can only estimate the risk of prostate cancer being present. A man’s PSA can be elevated for all sorts of reasons and careful urologic care is needed to decide if a prostate biopsy is required.”

Prostate biopsy is a minor office procedure that remains the only way to diagnose prostate cancer. While every procedure carries some risk of harm, the prostate biopsy procedure is very safe with few complications.

Fortunately, there have been a number of new medical advances to help men and their doctors determine when an abnormal PSA test is due to prostate cancer. There are a number of new blood and urine tests that identify cancer DNA that have become available over the past three years. Just like PSA, these new tests cannot definitively diagnose prostate cancer. “However, these tests are very helpful at reducing the number of unnecessary prostate biopsies done for falsely elevated PSA,” states Dr. Sutherland.

Even more exciting is prostate MRI, and specifically MRI-ultrasound fusion prostate biopsy. These exciting new tests can help find prostate cancer very accurately. “It is really exciting to see MultiCare investing in the new fusion biopsy system, which allows me to biopsy cancer that is visible on the MRI. Prior to this technology all prostate biopsies were performed by blind guess.”

Lastly, we are now performing genetic testing of a man’s family if he develops prostate cancer and meets criteria to do so. “Soon our management of prostate cancer will look very similar to how we manage breast cancer,” says Dr Sutherland. “Once a man is diagnosed, we will also make a plan for his brothers and sons.” This concept is especially important for African American men and men with a known family history of prostate cancer, both of which are 2.5 times more likely to develop prostate cancer.

Find a urologist near you for more information or to schedule an appointment.

Learn more about the origins of Movember and the importance of men’s health awareness.