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Prostate cancer. To test or not to test?

Wednesday 23 May, 2012 by Melissa

Nothing stirs up a bit of controversy like telling men not to have a test which may reveal they have prostate cancer.

It's a controversy which has made its way on the pages of daily newspapers here in Australia and across the globe over the past few days.

That's because a review of the evidence by the U.S. Preventive Service Task Force has recommended men should not get routinely tested. It argues the serious side effects of treatments in men with non-aggressive prostate cancer outweighed the benefits of testing for the disease.

So what is a PSA test?

A PSA (Prostate Specific Antigen) blood test looks for hormone (protein) levels in the blood, not for cancer.

If the PSA hormone level is found to be high, it can indicate there is some prostate issue and a GP or specialist may send a man off for further investigation of the prostate.
A high PSA level could be caused by other, non-cancerous problems.

So, it's not as simple as saying "a man has a high PSA level therefore he must have cancer." Men with a low PSA level can still have cancer.

The controversy comes from the fact that many men will be treated for prostate cancers detected by PSA that would have never caused them any harm. This "over diagnosis," as it's termed medically, and unnecessary treatment of harmless cancers can have serious side effects for many men.

There are also problems distinguishing between an aggressive prostate cancer that requires treatment, and one which is slow growing, not harmful and may not require treatment at all.

Side effects of treatment can include difficulty having erections, urinary incontinence, and the need to wear incontinence pads. It can sometimes lead to bowel incontinence as well.

It's hard to imagine living with the side effects of prostate treatment. Especially if you're a man who still has a good 30-40 years left on this earth (depending on the average life-span you look at and the age of diagnosis) and want a good quality of life. Obviously, these side effects can drastically impact both physical and mental health in men.

It is understandable men would want to get tested for prostate cancer.

When you look at the figures, here in Victoria alone, 4,398 men were diagnosed with prostate cancer in 2010, while 1,131 men died from the disease.

But, when you look at the facts;

  • More men will die due to other causes with prostate cancer which does not affect their lives in any way (that is there are no symptoms) than from prostate cancer.
  • The PSA test can't detect cancer. What is can do is indicate if further investigation is needed.
  • A high PSA level does not mean you have cancer - men with a low PSA level can also have prostate cancer.  
  • There is currently no program in Australia (or anywhere in the world) that tests all men of a certain age for prostate cancer. 
  • We know that around one in 48 men who have a prostate cancer picked up by a PSA test will die as a result of that cancer. This means the other 47 men with prostate cancer will likely go through treatment for a cancer that would have otherwise had no impact on their life.

For Australian men, it's hard to know what the right decision is.

There is agreement that a much better test is needed to screen for prostate cancer, but until that time, Cancer Council recommends men decide what is right for them individually when it comes to PSA testing.

There is no right or wrong decision. Speak to your GP about what is right for you, especially if you have a family history of cancer.

What are your thoughts on the debate gents? Would this study stop you getting a PSA test?

GP and PSA test blog photo
Picture: courtesy of freedigitalimages.net

Comments

This is a very important issue that doesn't get the attention it needs.

From: Sonja , 15/04/2013

I think Elvis would say 'thank you very much'.

From: Chelvis, 15/04/2013

I'm a bit dubious about the test. I just hope a more accurate test is available in future.

From: Mazzy, 15/04/2013

Thanks for raising awareness about this in your article Melissa, I wasn't aware of these important facts until now!

From: mel, 15/04/2013

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