From the Guidelines
Prostate exams are not necessary for all men, and the decision to undergo screening should be based on individual risk factors and a discussion of the benefits and harms with a healthcare provider. The most recent and highest quality study, 1, suggests that the harms of prostate cancer screening, including false-positive results, overdiagnosis, and overtreatment, may outweigh the benefits for many men. The American College of Physicians recommends that clinicians inform men between the ages of 50 and 69 about the limited potential benefits and substantial harms of screening for prostate cancer, and that screening decisions should be based on individual risk factors, overall health, and patient preferences.
Some key points to consider when deciding about prostate cancer screening include:
- The potential benefits of screening, including the possibility of early detection and treatment of prostate cancer
- The potential harms of screening, including false-positive results, overdiagnosis, and overtreatment
- Individual risk factors, such as family history and age
- Overall health and life expectancy
- Patient preferences and values
It's also important to note that the frequency of screening depends on individual risk factors and PSA levels, and that annual screening is not necessary for most men. As stated in 1, "no evidence supports annual screening for prostate cancer," and that "increasing the interval between screening tests may reduce harms."
In terms of specific guidance, the American College of Physicians recommends that:
- Clinicians should not screen for prostate cancer using the prostate-specific antigen test in average-risk men under the age of 50 years, men over the age of 69 years, or men with a life expectancy of less than 10 to 15 years
- Clinicians should inform men between the ages of 50 and 69 about the limited potential benefits and substantial harms of screening for prostate cancer, and that screening decisions should be based on individual risk factors, overall health, and patient preferences.
From the Research
Prostate Exam Necessity
The necessity of a prostate exam is a topic of ongoing debate in the medical community. Several studies have investigated the benefits and harms of prostate cancer screening, including the use of prostate-specific antigen (PSA) tests and digital rectal examinations (DREs).
- The US Preventive Services Task Force recommends that men aged 55 to 69 years discuss the potential benefits and harms of PSA-based screening with their clinician, as the net benefit of screening in this age group is small 2.
- For men aged 70 years and older, the Task Force recommends against PSA-based screening, as the potential benefits do not outweigh the expected harms 2.
- A study published in the Journal of Urology found that finasteride improves the sensitivity of DRE for prostate cancer detection, particularly for higher-grade tumors 3.
- Another study published in the Journal of Clinical Oncology found that factors associated with an increased risk of prostate cancer include high PSA value, rising PSA, family history of prostate cancer, abnormal DRE result, African American race, and older age 4.
Benefits and Harms of Prostate Cancer Screening
The benefits of prostate cancer screening include the potential to detect cancer at an early stage, when it is more treatable. However, screening also has potential harms, including:
- False-positive results, which can lead to unnecessary biopsies and treatments 2
- Overdiagnosis and overtreatment of slow-growing tumors that may not have caused symptoms or death 2
- Treatment complications, such as incontinence and erectile dysfunction 2
- A study published in the Journal of Community Health found that men's decisions regarding prostate cancer screening are influenced by factors such as perceived risk, fear of cancer, and skepticism about the benefits of screening 5.
Target Population for Prostate Cancer Screening
Prostate cancer screening may be more beneficial for certain populations, such as: