Naples, FL

Why Screen for Prostate Cancer?
By:  Michael F. D’Angelo, M.D.

Prostate cancer is the second most deadly cancer killer of men in the United States.  It accounts for almost 40,000 deaths per year and ranks as the most common solid organ cancer diagnosed in this group.  It is often a silent killer as most men with early stage prostate cancer have no symptoms.  What is remarkable is the fact that if diagnosed in an early stage, the cure rate is well over 90%.  How can such a curable cancer contribute to so many deaths?  The answer lies in the fact that thousands of men do not take the time or put out the small effort it takes to be screened.

Annual prostate cancer screening consists of a DRE (digital rectal exam) and a blood draw to determine the PSA (prostate specific antigen).  In the hands of an educated physician, the PSA combined with a proper DRE can predict a 25% to 65% chance of having a prostate cancer. Proper screening has led to the undisputed fact, that prostate cancer is one of a few cancers in which the death rate has fallen in recent years.

Prostate cancer screening should start around age 50 years for most men.  African-Americans and individuals with a family history of prostate cancer would benefit from screening starting at age 40 years.

There are three main indications for a male to undergo a biopsy of the prostate to rule out cancer.  If the PSA is out of the standard range, or if the DRE is abnormal, a biopsy is indicated.  A rapidly rising PSA velocity, even if the actual PSA value is normal, also warrants a biopsy.

An annual screening, which has to include both a PSA and DRE will certainly reduce the number of prostate cancer deaths.  So the question is not ‘why screen for prostate cancer?’ but truly ‘screen for prostate cancer, why not?’.