Health Education: Is there a problem with routine prostate screening?

“Take a Loved One to the Doctor,” an initiative launched by the “Tom Joyner Morning Show” (TJMS) and the Department of Health and Human Services Administration to raise health awareness in the African-American community, started as a once a year campaign. It is now a year-long campaign encouraging radio listeners to be proactive about their health conditions and make appointments for themselves and loved ones to visit health care professionals.

Prostate cancer is the second leading cause of cancer death among U.S. men resulting in approximately 28,170 deaths annually, according to the American Cancer Society. The TJMS initiative encourages African-American men to get routine check-ups. With the need to detect and treat prostate cancer as early as possible, the questions to be asked are: Is there a problem with routine prostate screening? Why is the U.S. Preventative Services Task Force’s draft recommendations against routine prostate screening? Does routine prostate screening create undesirable side effects? What are the pros and cons regarding prostate screening?

Prostate cancer is a form of cancer that develops in the prostate, a gland in the male reproductive system. The cancer may cause pain, difficulty in urinating, problems during sexual intercourse or erectile dysfunction. As a result, it is essential for doctors to use the digital rectal exam (DRE), as well as the prostate specific antigen (PSA) test to examine men with possible symptoms of prostate cancer. When the results of either tests are abnormal, additional testing is needed to determine if there is a cancer.

Recently, the U.S. Preventative Services Task Force (USPSTF) reported in “HealthPop – CBS News“ that routine prostate screening provides little or no benefit in reducing deaths resulting from prostate cancer. It gave PSA screening a grade “D” and recommended that men without symptoms should not routinely have the PSA blood test to screen for prostate cancer. The USPSTF grade is based on moderate certainty that the risks of testing equals or outweighs the benefit in men regardless of age. The USPSTF’s head, Dr. Virginia Moyer of the Baylor College of Medicine, said approximately 30 percent of men who are treated for routine prostate screening such as biopsies, radiation and surgery suffer significant side effects such as erectile dysfunction, infection, incontinence, impotence and even death.

Dr. Otis Brawley, chief medical and scientific officer at the American Cancer Society, noted in “HealthPop – CBS News,” “over-diagnosis of prostate cancer is what makes screening appear life-saving when it actually is not. Most of these men may never have a tumor progress to become deadly, but since they were screened and treated, they think screening saves lives. In fact, many people have a blind faith in early detection of cancer and subsequent aggressive medical intervention whenever cancer is found. There is little appreciation of the harms that screening and medical interventions can use.”

Many medical experts and groups oppose the USPSTF recommendations. As reported in “HealthPop – CBS News,” Dr. Deepak Kapoor, chairman and chief executive of Integrated Medical Professionals – the nation’s largest urology practice and Dr. Peter Schlegel, chairman of urology at New York-Presbyterian/Weill Cornell Medical Center in New York City, disagreed with the USPSTF’s recommendations. Schlegel noted the task force should have used better studies that showed substantial benefits from PSA screening and given a higher grade in order for doctors to discuss the risks and benefits with their patients. Schlegel also noted that the recommendations are inappropriately disadvantaged to African-American men since they face twice the risk for prostate cancer.

With the task force mainly concerned about the side effects due to the over-treatment of prostate cancer, doctors James K. Bennett, Jenelle Foote and Paul Alphonse of Midtown Urology in Atlanta position that “it is not the diagnosis of the disease that has led to these side effects, but the over-treatment of the disease which should be the basis of our discussion.” These doctors further stated that, in general, men are less likely to follow through on doctors’ appointments and are concerned that the recently announced task force guidelines provides men further justification to avoid seeking basic medical care despite their increased risk for diagnosis and death from prostate cancer. The Midtown Urology doctors believe the key to successful treatment of any cancer is early diagnosis and that there is a strong benefit for prostate cancer screenings for older men, African-American men and men with a family history of prostate cancer.

During the announcement of USPSTF’s recommendations, which was released the same time of an annual meeting of the American Urological Association, the group reported on CBS News that the recommendations were “inappropriate and irresponsible.” Dr. Herber Lepor, the head of urology at NYU Langone Medical Center also noted that he did not believe the medical evidence supported the task force’s conclusion. According to Lepor, “The PSA has taken us down the road to decreasing the risk of prostate cancer deaths. We all recognize we have a long way to go to perfect screening, but the last thing we need to do is turn back.”

The debate regarding the value of prostate cancer screenings will undoubtedly continue. In the meantime, it is critical that men educate themselves about prostate health and work collaboratively with their doctors to take steps to maintain a healthy life style and get the necessary physical exams to detect health issues. As men, our responsibility is to protect the people we love by proactively protecting our health.

Dr. Ronald Holmes is the author of two books, “Education Questions to be Answered” and “Current Issues and Answers in Education.” He is president of ”The Holmes Education Post,“ an education focused Internet newspaper. Holmes is the national superintendent of education for the National Save the Family Now Movement, Inc., a former teacher, school administrator, and district superintendent and can be reached at [email protected]