What is screening?
Screening is where a group of people are tested for a condition even though they have no symptoms of that condition. Cancer screening involves testing apparently healthy people for signs that could show that a cancer is developing. Breast screening in females is something we are all familiar with – where females between ages 50 and 70 have their breasts ‘x-ray’d’ and checked for breast cancer every 3 years even though they might not report any lumps, bumps or anything else. The idea behind screening is to pick up disease early – even before it starts to show symptoms because then one can possibly cure a patient if things are caught early enough. In a similar fashion to breast screening in females, some argue that men should be screened for prostate cancer. This might seem like a good and logical thing to do but there are big draw backs. We will outline these below.
So, should I have my prostate checked if I have no symptoms?
This is a very difficult question to answer. We all know that cancer is a bad word and it scares the living daylights out of us. But the story with prostate cancer is different. Even the medical specialists in prostate cancer can’t agree whether patients should be checked out for prostate cancer – this is why there is no national screening programme for prostate cancer in the UK.
- Some experts say: That there is no point checking a patient out (screening) for prostate cancer because most are so slow growing that it wouldn’t affect the patient. The patient is more likely to die of something else. The majority of PSA-detected prostate cancers are harmless.
- Other experts say: Not all prostate cancers are the same. A small proportion of prostate cancers are aggressive and not slow growing and that sorting these out will save lives. Results from a landmark European-wide trial (called ERSPC) have shown that screening for prostate cancer can reduce deaths from the disease by 20%.
- But the other experts then say: But the proportion of those types of angry agressive cancers is very small. Most are slow growing.
- They also say: The current test for prostate cancer is a blood test called the PSA. The problem with the PSA is that on its own, it isn’t a very good test for picking up prostate cancer because
- It misses quite a number of patients who do have prostate cancer (about 20%).
- And it certainly doesn’t help you tell the difference between an angry aggressive cancer and the more common slow growing one.
- It is not reliable. In fact, it also creates worry by falsely indicating in some patients who dont have prostate cancer that they do! About two-thirds of the men with a raised PSA test will NOT have prostate cancer.
- Imagine all the anxieties this causes in all those patients who are falsely picked up – there are a large number of them.
- If the PSA is raised, a biospy of the prostate will be required – which is an uncomfortable experience and some men say painful. Complications of the biopsy include bleeding (1 in 3 men get bleeding) and infection. The biopsy might still miss picking up any cancer (about 20%) and because of this, if the biopsy is negative, you’ll probably need another one later on again! Can you face going through all of that?
- The first set of experts then say: but some people’s lives will be saved at the end of the day. And picking up people earlier means we can offer them more options in terms of treatment.
- But then the second lot of experts say: but you have to screen roughly 1400 patients to save one life. Furthermore, you have to treat 49 patients with prostate cancer to save one life. The other 48 will have had to endure the side effects of treatments and tests for very little benefit. And even if you treat with surgery or radiotherapy – patient’s may experience side effects from these that can really harm the remainder of a patient’s life even though in a small number there may be a possibility of a cure.
And so the story continues. So, unfortunately, it is the patient has to make their own decision about this. Of course, please talk to your GP for a more informed discussion before you make your choice. We do understand the difficulty in you making a decision for yourself – if the experts can’t agree, how can we expect you to? But hopefully, your choice may be a little clearer after reading up about it first (see links below) and then talking to your GP about it.
Cancer specialist Dr Chris Parker says this about prostate screening…
- “It is in some ways a lifestyle choice,” says Dr Parker. “If you want to do everything to maximise your chances of living to a great age, and are willing to risk the side effects of treatment, then PSA testing makes sense.
- “If, on the other hand, you are more accepting of your ‘allotted span’, and are keen to preserve normal sexual and urinary function, then you may decide not to have the test.”
Are there any groups at greater risk of prostate cancer?
Yes. Black men and those with a family history of the disease are at greater risk and might have more to gain from testing.
Are there any good websites or online resources to help me make my decision?
You do need to do some reading to help YOU make a decision for YOURSELF. Of course, you can then make an appointment with your GP to clarify matters and to help you come to that decision making point. One thing the experts do agree on is that if a patient has a life expectancy of less than 10 years and are not in good general health, then it is unlikely that prostate screening is worthwhile.
To help you make a decision about whether to be screened…
- A good website about prostate screening and to help you make a decision is this one. Click here. (cancerscreening.nhs.uk)
- Another great website about the pros and cons of prostate screening. Click here. (mayoclinic.org)
- And yet another website about the pros and cons of prostate screening. Click here. (www.nhs.uk)
- This leaflet might also help you with your decision about whether to have a PSA test. Click here (cancerscreening.co.uk leaflet)
- This leaflet helps you to figure out the pros and cons of having the test for you. Click here. (www.cancer.org)
- As might this leaflet which tells you about the number of patients needed to treat in order to save a life. Click here (bradfordvts)
For general information about Prostate Cancer and Screening…
- For more general information about Prostate Cancer and its screening… click here (medicinet.com)
- And finally, if you just want to learn more about the prostate, prostate cancer and anything you can do reduce your risks, Click here. (zerocancer.org)
- Another general site about prostate cancer. Click here. (prostatecanceruk.org)
For Prostate Cancer Support Groups…
- www.prostatecancersupport.info
- www.cancerresearchuk.org
- www.prostatecancerfederation.org.uk
- www.tackleprostate.org
What if I do have symptoms of a Prostate problem?
Then you MUST go and see your doctor within a week or two. People who have trouble with their prostate usually have one or more of the following symptoms….
- Going to the toilet to urinate (pee) often.
- Going to urinate at night time
- Noticing that the urine stream isn’t quite as good as when they were younger
- Noticing that the urine takes a little while to come out compared to when they were younger
- Noticing that at the end of urinating, having to stand at the toilet for a while until all the dribbling has stopped.
However, if you have one or more of these symptoms, this doesn’t necessarily mean you have prostate cancer. It could simply mean that you just have a big prostate which might need medication to help shrink it down. The point is this: if you have any of these type of urinary symptoms, PLEASE GO TO YOUR DOCTOR WITHIN A WEEK to get checked out. Do not delay.