Prostate cancer screening is an attempt to identify individuals with prostate cancer in a broad segment of the population—those for whom there is no reason to suspect prostate cancer. Prostate cancer is a disease which only affects men. Cancer begins to grow in the prostate – a gland in the male reproductive system. Prostate cancer is mostly a very slow progressing disease. In fact, many men die of old age, without ever knowing they had prostate cancer – it is only when an autopsy is done that doctors know it was there. Prostate test screening is controversial. There are currently two methods used: One is the digital rectal examination (DRE), in which the examiner inserts a gloved, lubricated finger into the rectum to examine the adjoining prostate. The other is the prostate-specific antigen (PSA) blood test, which measures the concentration of this molecule in the blood.
It is difficult for a physician to determine how the cancer will proceed based on the two major types of screening tests currently available alone. However, once prostate cancer is diagnosed, well-established criteria can be analyzed to determine which cancers need to be treated and which can be safely observed. For elderly men with several medical issues, screening may be more harmful than beneficial, but for younger, healthy men, screening can reduce death from prostate cancer. Screening younger men and men at risk of prostate cancer can be beneficial in reducing metastasis cancer and deaths and should not be abandoned. Healthy younger men also are at lower risk of complications from biopsies and treatments compared with older men.
Cancer-specific mortality, not overall mortality, is the primary outcome in screening trials. However, because deaths from prostate cancer are a small proportion of all deaths, comparisons of overall mortality are underpowered. Thus, a screening program that reduces cancer-specific mortality should not be stopped because of a lack of reduction in overall mortality. Screening can also reduce the incidence of metastasis cancer. There is 41% reduction in metastasis disease at diagnosis of the cancer with screening. The decision to screen or not to screen should be individual as screening is not appropriate for every man. Rather than abandoning a screening test that reduces death and suffering, efforts should be focused on selecting patients more carefully. Screening should be encouraged for healthy younger men and men with risk factors (e.g., black ancestry, positive family history) and discontinued for elderly men with multiple co-morbidities and limited life expectancy.