Still getting your routine prostate cancer screenings? Well...don't.
Turns out that prostate cancer screenings may do more harm than good. Men over 50 may not need routine prostate cancer screenings as they can lead to infection and a host of other complications. Read below to learn more...
Dr. Khan: So basically what physicians used to do was annual prostate cancer screenings on men. We would take a look at their prostate cancer screening blood work (PSA) and do a
digital rectal exam.
Interviewer: And what are PSAs?
Dr. Khan: Prostate specific antigen. It’s allegedly put out as the prostate enlarges with the thought that if the prostate has enlarged significantly beyond what is an age-related norm, then your PSA levels are going to skyrocket much quicker than they would if someone suffered from a benign large prostate that is common for some men as they age. So physicians used to do annual screenings to see what your prostate numbers were, how quickly they were going up, and on the basis of that they would determine whether or not someone would need to go to a urologist to get biopsies done.
Interviewer: Now at what point do people usually get prostate cancer screening nowadays?
Dr. Khan: See, here’s the thing. There are still a lot of individuals that look to get prostate cancer screening done because they’ve been getting it done for years and there are a lot of doctors that will go ahead with that because that is what they have been taught is the appropriate thing to do. However, we need to keep in mind that screening means screening individuals that are entirely asymptomatic (individuals who do not show any symptoms). So people that ARE NOT getting up multiple times a night to urinate, people that DON’T have problems with their urinary stream, people that DON’T have issues with urination or lower urinary tract symptoms are getting this blood work done.
So what recent evidence has demonstrated is that fine, yes, go ahead and do it based on your PSA numbers but for every 1000 people screened, 280 will have an elevated PSA. Of these, 178 will be false positives.
Interviewer: And this is part of the prostate cancer screening process?
Dr. Khan: This is part of what ends up happening if you get dinged as somebody who may have prostate cancer based on the blood work.
Interviewer: So what is the next step that they take after initially seeing a physician.
Dr. Khan: You end up seeing a urologist and you have a discussion with him or her and you may end up having a biopsy of the prostate where basically a whole bunch of biopsies of the prostate gland are taken under direction of a transrectal ultrasound probe.
Going back to the 280 men with elevated PSAs. Of these 280, only about 102 will have cancer. Of the 178 people with NORMAL PSAs, 4-6 will still have cancer. Of the 280 men we biopsy 5 will suffer severe enough complications due to the procedure that will have to be hospitalized. So, that is 178/1000 men undergoing an unnecessary painful test, 5/1000 having severe and life threatening complications, and 6 missed diagnoses.
Let's set aside the roughly 65% of men who have now unnecessarily undergone an invasive and painful transrectal ultrasound guided biopsy of the prostate. Of the 102 people who actually get diagnosed with prostate cancer, 33 will see no improvement (or even see a deterioration) in their overall health with treatment as their cancers would never have caused illness or death. So, to sum up, at this juncture, 211 of 1000 men have been harmed due to prostate screening either due to unnecessary procedures, or unnecessary treatment that has a 44% chance of erectile dysfunction, a 21% chance of causing complications that require further intervention, an 18% change of incontinence and a 0.5% chance of death.
Of the remaining 69/1000 men, 5 will die due to prostate cancer. Had these 1000 men not been screened 6 would have died.
Interviewer: So just to summarize what you said. You basically explained that prostate cancer screening should not be done on individuals who do not exhibit the symptoms for prostate cancer. Also, the procedures that men have to go through or the processes that men have to undergo to get a prostate cancer screening have negative effects in the end because the biopsy and eventual treatment can lead to significant side effects.
Dr. Khan: Correct. Now, if someone shows high PSA levels after getting their blood work back, that needs to be investigated so in that case, a urologist may decide that a prostate biopsy has to be done. The chances of actually catching somebody with prostate cancer are LOWER than the chances of getting harmed by the overall screening process.
In summary, if you take a thousand men and screen them for prostate cancer, you will save 1 life, help an additional 63 men, do nothing for 720 of them, and most alarmingly, harm 211. The five missing men have passed away, and would have regardless of whether they had been screened or not.
If these numbers concerns you, they should. They concerned the Canadian Preventative Task Force of 2014, the Canadian College of Family Physicians, the US Preventative Task Force of 2012 to unequivocally state that men should not undergo routine PSA screening. Even the Canadian Cancer Society suggests that men should be thoroughly educated about these statistics and risks prior to screening.
Interviewer: How would somebody know if they have high PSA levels?
Dr. Khan: Through routine blood work. You may come in to get a check up and find out from your doctor that your PSA levels are high. Otherwise, if you are showing symptoms of prostate cancer, a physician may order blood work for your PSA levels as well. If your PSA levels were also elevating throughout the years, that can also be an indication and your doctor would mention that to you as well. In general, my recommendation is that people don’t undergo routine PSA screening UNLESS they have lower urinary tract issues. Family physicians should also generate awareness with their patients that have been getting routine prostate cancer screenings such that hey, you don’t need to do this anymore and here is why.
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Disclaimer: All information and opinions are that of Dr. Khan’s and Dr. Khan’s alone. These blog post interviews are based off of current research and evidence. If you have any questions or concerns, feel free to drop by at the clinic!
