04.Prostate cancer screening
Prostate cancer can be present in an early and potentially treatable form without any symptoms, but if it’s detected from symptoms later on, the chance of a cure is low. In Australia’s Health 2008, the Australian Institute of Health and Welfare said:
- The lifetime risk of prostate cancer for men is one in five (20%).
- Prostate cancer is responsible for 29% of cancers in men (excluding non-melanoma skin cancers).
- Prostate cancer is the second-most common cause of cancer deaths in males.
Possible prostate tests
Prostate cancer screening is controversial because many older men who screen ‘positive’ will undergo treatment with side effects such as incontinence and impotence. Elderly men are more likely to die of something else before prostate cancer claims their life. If you’re middle-aged rather than elderly, testing makes sense because the chance of dying from this often slow-growing cancer is much greater when it occurs at a younger age.
Prostate cancer often raises the levels of prostate specific antigen (PSA) in the blood, which is measured with a blood test. The acceptable level varies with age – 2.5 the maximum for the 40-49 age group, and 5.5 the maximum for the 70-79 age group. About 75% of positives are false alarms, and one study showed half of all men with an abnormal PSA returned to normal when tested six weeks later.
About 15% of men with prostate cancer will not have a high PSA. The false negatives and false positives contribute to the controversy around PSA testing. As well as a PSA test, your GP is also encouraged to perform a digital rectal examination (DRE) – checking the prostate by feel which will pick up about half of all tumours over 10mm. Medicare will cover one PSA test per year, and any subsequent tests to monitor suspected cancer. Guidelines for general practitioners suggest individuals need to make their own decision about prostate screening after being fully apprised of potential risks and benefits. The Urological Society is slightly more proactive, recommending that men aged between 50 and 70 with at least 10 years’ life expectancy should have PSA and DRE yearly after counselling.
For more information to help you decide if a prostate cancer screening test is right for you, go to www.andrologyaustralia.org/docs/PSAdecisioncard20041007.pdf
Cancer Council Australia
Cancer Helpline 13 11 20 (cost of a local call)