To Check Or Not To Check Your Prostate?

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Let’s address a conversation that I’ve had with my male patients given some new recommendations about prostate cancer and screening. When adult men come in for their annual physical exams, especially those older than 50, most are prepared to have the uncomfortable and unpleasant experience of a rectal and prostate exam.

The U.S. Preventive Services Task Force (USPSTF) is the nation’s most knowledgeable group of medical experts who put together what the official recommendations for health maintenance should be. In the past, the recommendation was to screen all men at 50 and older (45 and older for Black men or those with a family history of prostate cancer), have both a digital rectal exam to examine the prostate and a blood test called the prostate specific antigen (PSA).

It was thought that this was the best way to screen and find early prostate cancers. For a long time it was a debatable topic. However, in November 2012, the USPSTF’s official recommendation was made against yearly DREs and PSAs. We were told NOT to do them. Research has found that it has caused more harm than good.

The rationale is the majority of all men by the age of 80 or 90 will have some form of prostate cancer. It is also true that the cancer will likely be benign or non-life threatening. So the question was asked if it was worth finding a non-life threatening problem earlier versus later when it wouldn’t save lives.

The other part of the issue was what I mentioned earlier – the idea of harm. Harm is caused, potentially, in doing the exam (it’s not a comfortable one to have), finding something abnormal or having an abnormal PSA level, and having to “chase it” down. PSAs can be elevated for reasons other than cancer, such as having an enlarged prostate or bacterial infection. But once an elevated PSA is found, it’s hard to convince anyone that you shouldn’t look further and rule out cancer.