Prostate Screening
Can prostate cancer be found early enough to be cured?
There are still many uncertainties about the early detection of prostate cancer. Cancers can be found by screening, using the PSA blood test and/or DRE. And, they are usually found at an earlier stage—smaller and less likely to have spread—than cancers found after they cause symptoms.
Thus, prostate cancer can be found early, but the unsettled question is whether this is good or bad. Prostate cancer is unlike most other cancers in that it tends to grow very slowly, and a large proportion of men who have the disease have an insignificant amount of it that never causes problems. And, there are questions about the effectiveness of the available treatments. For cancer that is proved not to have spread outside the prostate gland, five-year survival is near 100%, with or without treatment. But, it is not known whether treatment will enable them to live longer.
On the other hand, before screening tests were widely used, most men with prostate cancer were diagnosed with advanced disease, and most died within a few years of the diagnosis. Although early diagnosis and treatment of prostate cancer may help some men to live longer, it will have no impact on the life span of other men. And prostate cancer treatments can affect a man's quality of life.
Since testing for early detection of prostate cancer became relatively common (about 1990), the prostate cancer death rate has dropped. But it has not been proved that this is because of screening, in particular PSA screening. Studies are underway to try to determine whether screening can really lower the prostate cancer death rate, but results will not be available for several years. Until then, most medical and physician organizations recommend that the decision to get screened should be left up to the individual and his healthcare provider after receiving information about the potential risks and benefits of early detection and treatment. The one exception is a man at higher risk for prostate cancer, for whom early detection efforts are more widely recommended.
