The Silent Epidemic: The Pros And Cons Of Screening For Prostate Cancer

“You will consciousness a small pressure.”

My expert had instructed maine to little my boxers, crook guardant and spot my elbows connected nan table. As pinch astir men complete 50, it was clip for my yearly integer rectal exam, aliases DRE: those riveting moments erstwhile nan expert takes a “look” astatine nan prostate gland, which is conscionable beneath nan bladder and successful beforehand of nan rectum.

Its position makes nan introspection difficult. The expert inserts a well-lubricated digit into nan patient’s rectum to consciousness for abnormalities specified arsenic lumps, nodules aliases areas of hardness. As uncomfortable arsenic nan process tin be, successful my experience, it seldom lasts for much than 10 seconds.

As always, she said everything looked fine. In my unreserved to propulsion my boxers up and alteration nan subject, I didn’t fuss to inquire immoderate much questions. At nan time, I was clueless that arsenic men age, nan prostate becomes progressively susceptible to cancer.

In nan uncommon arena nan illness tops nan news cycle, it’s because of high-profile diagnoses, specified arsenic for erstwhile US president Joe Biden successful May, Nelson Mandela, Robert De Niro and nan Chicago Cubs hallway of famer Ryne Sandberg, who died successful precocious July. Even so, important specifications of nan unwellness often spell unreported. I – for illustration galore others – typically dismissed nan taxable pinch a yawn, being of nan uninformed but persistent belief that it’s “the champion crab to have”. All I knew was that prostate crab tends to move slow and tin beryllium successfully treated erstwhile detected early.

Now I americium a prostate crab survivor, whose prostatectomy successful 2020 almost came excessively late. I didn’t cognize that successful nan US, prostate crab is nan 2nd starring origin of cancer decease successful men. One successful 8 will beryllium diagnosed pinch it. One successful 44 will dice from it.

Being uninformed astir those specifications and testing options could person killed me.

“Prostate crab has been called nan Silent Epidemic,” said Dr Samuel L Washington, a urologic surgeon who specializes successful oncology astatine nan University of California successful San Francisco. Even pinch an progressive lifestyle, patient nutritional regimen and integer screenings, crab tin sneak successful undetected.

“Many men pinch prostate crab won’t acquisition immoderate outward signs aliases symptoms until nan illness is advanced, which is why testing is truthful critical,” said Dr Clifford Gluck, a urologist and Founder of Dr Gluck’s Wellness Center successful Massachusetts. “If not caught early, it tin break free of nan prostate and tally unchecked done nan body, pinch a peculiar penchant for bone.” Once prostate crab has dispersed to different parts of nan body, nan five-year comparative endurance complaint is only 37%.

“In 2023, only astir 38% of men betwixt 50 and 64 were screened for nan disease,” said Washington. “Sadly, a deficiency of screening remains 1 of galore factors starring to accrued rates of men presenting pinch much precocious illness complete nan past decade. The much precocious nan cancer, nan harder it is to treat.”

Before my 62nd year, I routinely postponed my yearly physical, assuming I was bulletproof. I was diversion and ate a plant-based diet. My life was free of processed foods, recreational drugs, tobacco, asbestos and weapons-grade plutonium. I knowledgeable nary symptoms suggestive of prostate cancer, specified arsenic erectile dysfunction aliases urinary issues that reportedly led to the erstwhile president’s diagnosis.

Then, aft a mates of cross-country moves pinch my family, I nary longer had a superior physician. Dismissing my claims of invincibility, my woman handed maine a database of internists. I booked a physical, and my caller expert ordered my first-ever PSA (prostate-specific antigen) test. PSA is simply a macromolecule produced by nan prostate. Normal and cancerous prostate cells nutrient it, but cancerous ones tend to nutrient more. That said, an elevated PSA level is not ever suggestive of cancer.

Generally, a normal, aliases non-elevated people for men complete 60 is nether four; for men nether 59, nether two-and-a-half; and for younger men, nether one. But “PSA levels disagree for each person,” said Dr Ash Tewari, professor and chairperson of nan section of urology astatine nan Icahn School of Medicine astatine Mount Sinai. “While scores beneath 4 are preferred, it is astir important to understand whether a PSA level is changing from twelvemonth to year.” Variables specified arsenic family history, wide health, nutrition and title tin person an effect. “At nan very least, I impulse patients to person nan speech pinch their doctor,” he said.

Mine was a harrowing 17. My expert called, speaking pinch a breathless urgency that made maine consciousness I mightiness not unrecorded to nan extremity of nan conversation. “It’s almost certain,” he said, “that you person prostate cancer.”

The PSA trial is simply a common, though imperfect, screening trial for prostate crab recommended by galore urologists and superior attraction physicians for men starting astatine property 50. It is besides 1 of nan only ways to drawback prostate crab early. I asked my 2 erstwhile superior attraction physicians why they had ne'er ordered one, and they based on that nan trial sets disconnected excessively galore mendacious alarms and causes undue stress; elevated PSA levels tin beryllium symptomatic of issues different than cancer, specified arsenic an infection. Also, I had ne'er asked for one. (They must person confused my BA successful English pinch a aesculapian degree.)

After proceeding I had been diagnosed pinch prostate cancer, 1 conceded: “In hindsight, a PSA trial would person been a bully idea.”

Their reluctance is not unusual. Many doctors successful nan US awkward distant from prescribing nan trial because of nan uncertainty of what an elevated people means, really patients respond to that uncertainty and risks associated pinch consequent exploratory procedures for illustration biopsies.

A PSA trial tin correctly bespeak that prostate crab is present, arsenic it did for me. But it tin besides consequence successful a mendacious positive, suggesting crab is coming erstwhile it isn’t (6 to 7% per screening round); a mendacious negative, aliases not picking up that crab is coming (according to nan UK’s National Institute for Health and Care Excellence, 15% of group pinch a normal PSA trial consequence whitethorn person prostate cancer); aliases catching slow-growing cancers that mightiness ne'er person caused issues.

The second is called overdiagnosis, and curen tin expose “a personification unnecessarily to imaginable complications”, according to nan National Cancer Institute: these see urine leakage, accrued urination, loose stools aliases rectal bleeding, and nonaccomplishment of erections aliases decreased erections. Current estimates propose that 20%–40% of screen-detected prostate cancers whitethorn ne'er person caused harm, pinch consequence varying by age, PSA levels, and Gleason Score.

“There are risks to nan test,” said Dr Nancy L Keating, MD, MPH, professor of healthcare argumentation & medicine astatine Harvard Medical School. The PSA trial has a C standing from nan US Preventive Services Task Force (USPSTF). For context, an A standing intends nan USPSTF strongly recommends nan test. A C intends doctors whitethorn connection it, “but that patients should make an individual determination astir screening aft discussing imaginable benefits and harms pinch their doctor”, said Keating.

“There appears to beryllium a humble use to screening for immoderate men,” said Keating. “But astir prostate cancers are not apt to beryllium deadly, and galore men will acquisition nan harms of screening, specified arsenic worry and unnecessary biopsies, and treatments for illustration radiation aliases removal of nan prostate that tin lead to incontinence and erectile dysfunction, without experiencing benefits,” said Keating, who thinks it is important for patients to understand nan test’s limitations.

In one 2024 study that followed much than 400,000 men aged 50-69, 1 invitation to do a PSA trial produced a mini mortality benefit. “The mini simplification successful prostate crab deaths by utilizing nan trial to surface patient men does not outweigh nan imaginable harms,” Professor Richard Martin, lead writer of nan study and crab investigation intelligence astatine nan University of Bristol successful nan UK, said astatine nan time. “This results successful immoderate men going connected to person invasive curen that they don’t need, galore years earlier than without screening, and nan trial is besides failing to spot immoderate cancers that do request to beryllium treated.”

Regret pursuing a prostate biopsy isn’t uncommon – moreover erstwhile nary crab is found. A 2024 multicenter cohort study reported that astir 5% of men regretted undergoing nan procedure, often owed to pain, bleeding, aliases unexpected psychological distress. In qualitative studies, men who believed they had been overdiagnosed and unnecessarily treated reported lasting regret, uncertainty, and affectional distress – moreover years aft treatment.

Men much susceptible to prostate cancer, and truthful much apt to use from a PSA test, see African American men, men pinch a family history of prostate cancer, and those pinch familial mutations specified arsenic BRCA1 aliases BRCA2, according to nan American Cancer Society.

Gluck noted that nan PSA trial has a debased USPSTF people “primarily owed to concerns astir side-effects from room aliases radiation treatments”. But advances successful technology, curen and surgical techniques – specified arsenic high-intensity focused ultrasound (HIFU), a non-invasive curen that uses targeted sound waves to destruct prostate crab while preserving urinary and intersexual usability – make screening a “far much favorable proposition” now, he said.

My PSA people decidedly spiked my anxiety, contempt knowing I mightiness only person an infection. The only measurement to find what it meant was an MRI and a prostate biopsy. I dreaded nan biopsy, which was to a integer exam what a guidelines canal is to flossing. My urologist explained that location were immoderate risks, specified arsenic infection and mendacious negatives, but for me, confirming whether I had crab acold outweighed them.

Nothing astir these processes counted arsenic pleasant. For nan MRI, I was ensconced successful nan instrumentality for astir 40 minutes. A week aft that, nan expert inserted an ultrasonic probe into my rectum to guideline him arsenic he extracted 12 mini samples of my prostate. The biopsy redefined my conception of vulnerability, but though it seemed for illustration hours, it took little than 20 minutes – and anticipating nan symptom was worse than nan existent pain. After a fewer days of mild tenderness, I was backmost to normal.

For each of nan interest and discomfort, if nan biopsy revealed nary trace of cancer, I would person uncorked nan champagne. Unfortunately, my results showed a high Gleason score – which measures really different crab cells look nether a microscope compared pinch normal cells – accordant pinch fierce prostate cancer. But I was relieved to perceive that nan illness hadn’t dispersed beyond nan prostate membrane. Had I waited different 2 aliases 3 months, according to my post-operation pathology report, it astir apt would have.

Six weeks aft nan biopsy, I underwent a extremist robotic nerve-sparing prostatectomy, a astir five-hour cognition to region nan prostate utilizing minimally invasive tools. Finding information connected success rates was frustrating fixed nan myriad factors that tin impact nan outcome, which see Gleason scores, age, health, obesity, comorbidities and whether aliases not nan crab has metastasized beyond nan prostate. I banked connected my fittingness and nan accomplishment of my surgeon arsenic deciding factors to acquisition nan operation. My top fears were semipermanent incontinence aliases erectile dysfunction, but I was fortunate not to suffer either.

As fortunate arsenic I was, earlier testing and discovery would person afforded maine much curen options. “The benefits of early discovery can’t beryllium overstated, which is why I counsel men betwixt 50 and 70 years of property to person a PSA chat annually,” said Tewari. “PSA screening mixed pinch imaging is an important attack to efficaciously surface for prostate cancer.”

It took moving crossed nan country, my wife’s diligence and a expert who routinely prescribed PSA tests for my crab to beryllium diagnosed. It was a analyzable road, and experts’ divergence connected nan effectiveness of screening show conscionable really difficult it tin beryllium for a layperson to make these kinds of aesculapian decisions. It’s not perfect to trust connected a testing action that astatine champion results successful an estimated 10 retired of 1,000 people avoiding decease from prostate cancer, pinch curen options that tin consequence successful incontinence and intersexual dysfunction.

But taking nan trial erstwhile I did had a melodramatic impact. It saved my life. At nan very least, I wish I’d had an earlier opportunity for a elaborate chat pinch my doctor. Given what I cognize now, I would person preferred screening and early detection, because for me, location is nary specified point arsenic nan champion type of cancer.

• Ed Manning is simply a 67-year-old exertion executive, jazz pianist and freelance writer who is penning a memoir astir surviving prostate cancer