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Prostate Cancer Exam: What's the Controversy About?

Summary & Participants

There's an ongoing debate within the medical community about the merits of routine screening for prostate cancer. Get the latest information and one expert's view on the controversy.

Medically Reviewed On: July 01, 2008

Webcast Transcript

ANNOUNCER: Prostate cancer is one of the most common cancers among men in the U.S. It's estimated over 30,000 will die of the disease this year. Yet there is an on-going debate in the medical community, about the merits of routine screening. When to get screened, who should be screened, what to do if screening is positive, and can screening actually save lives, are the key questions being considered. One expert discusses his views on the screening process.

DEREK RAGHAVAN, MD, PhD: The issue of screening in prostate cancer is very controversial. And there are two levels of screening. The first is to try to make the early diagnosis. And there are mechanisms in the community that allow an examination called the digital rectal examination. That involves a surgeon or a physician inserting a finger that's covered with a glove, has some lubricant jelly on it, into the rectum to actually examine the prostate gland, which sits just to the front of the rectum. If it's irregular, if it's enlarged that might indicate the presence of cancer.

There's also a test called a PSA test, that stands for prostate specific antigen, which is a blood test. And in general, a high level of PSA will indicate the potential for there to be cancer present. Unfortunately or fortunately, there are other conditions of the prostate that can push the PSA up. There's a condition called benign prostatic hyperplasia, which is a benign enlargement of the prostate. And then men who are sexually active will sometimes get infections and inflammations of the prostate called prostatitis. Both those conditions will push the PSA up.

ANNOUNCER: If the findings of a PSA test and rectal exam suggest cancer and a biopsy confirms it, the next step is making a decision on treatment. Herein lies the controversy.

DEREK RAGHAVAN, MD, PhD: And the controversy relates to whether in fact making that early diagnosis is useful for patients. In other words prostate cancer has a very variable natural history. That means a very variable pattern of growth. Many men who have prostate cancer have a condition that just sits very quietly for years and years.

I think many clinicians feel that you can really just heighten the level of anxiety of a patient by screening on a regular basis. So certainly in my practice, what we tend to do on a routine follow-up is, we examine the patient and take a very careful history.

Sometimes the screening will identify a patient who really doesn't need to have any treatment. Classically an 80 year old, and 85 year old who has seven or eight other medical conditions, may not be around long enough from his natural life expectancy to have trouble with his prostate.

ANNOUNCER: A recent New England Journal of Medicine article added fuel to this controversy. It reported the results from a large Scandinavian study that found surgery upon initial diagnosis, reduced the number of deaths due to prostate cancer compared to the "watch and wait" group.

However, there was no difference in overall mortality between the two groups. In other words, surgery may be helpful for certain individuals, for example younger men, in relative good health, with localized aggressive disease. But for others, like older men with multiple health problems, it may not make a difference because they are more likely to die from some cause other than prostate cancer.

DEREK RAGHAVAN, MD, PhD: The critical issue is whether you end up accidentally treating people for a condition that was never going to be dangerous to them. That's the basis of all the controversy that surrounds the management of prostate cancer.

ANNOUNCER: Though there are differences of opinion about prostate cancer screening and who will benefit from treatment, the current recommendation from the National Cancer Institute is that men at average risk begin screening at age 50. While more studies are underway to try and clarify the situation, the decision to be screened and what to do if prostate cancer is detected, is one that each patient should make, in consultation with his doctor.