- The prostate is a small gland, the size of an walnut, that sits below the bladder.
- If enlarged, it causes urinary symptoms such as poor stream, having to urinate more frequently, getting up at night multiple times, difficulty in finishing emptying the bladder.
- It’s a common site for cancer in older men
- The PSA (Prostate Specific Antigen) blood test goes up with prostate disease:
- The problem is, it goes up with a non-cancerous (benign) enlargement of the prostate, which might not be causing any problems, as well as with cancer.
- Tests that can distinguish more accurately between benign and cancer include biopsy (needles put into the prostate under local anaesthetic, going up through the back passage) can be expensive, painful and carry some risks.
- Prostate cancer takes a great range of forms, from very aggressive, to very slow growing which would never cause any symptoms.
- Prostate cancer treatment has a high risk of side effects.
Who should be tested, and what should we do with the results?
If you test men age 60 (without a father or brother with prostate cancer) every year with a PSA for the next 10 years:
- 2 men out of 1000 will avoid death from prostate cancer
- 2 men out of 1000 will avoid metastatic prostate cancer (cancer that has spread, e.g. to bones)
- 87 men will have had a positive PSA test, but after biopsies, turn out not to have prostate cancer
- 28 men will have had a bad enough side effect from the biopsies that they consider it to be a moderate or major problem, maybe needing health care
- 28 men will have had prostate cancer diagnosed, many of whom would never have got any symptoms from it
- 25 men will go ahead with treatment (surgery or radiation) because of the uncertainty about exactly which cancers need to be treated, many of whom would do well without treatment (i.e. they are over-treated)
- 7-10 of these 25 men will have serious side effects of treatment – impotence, incontinence or bowel problems
So – Prostate Cancer testing is like most things in Medicine – not as clear cut as you might think. Have a discussion with your regular GP, who can discuss your overall risk / benefit ratio and give you the right advice.
We are here to help!
Ref: National Health and Medical Research Council, 4 March 2014.
Disclaimer – this is a quick outline summary and not designed to be comprehensive. The views expressed are personal doctors opinions.