Regular prostate screenings are too useful to forgo

Last week, the American Cancer Society repeated its recommendation that prostate cancer screening should not be a routine part of men's regular exams. Among other things, the society stated that PSAs and digital rectal exams lead to false positives and to finding cancers that never should have been treated because they weren't aggressive enough to be fatal.

Then why am I such a strong proponent of screening? Simple. Cure rates have improved dramatically over the last 20 years, because tumors are being caught early — thanks to screening. Furthermore:

• The cancer society position that many men could have avoided treatment for prostate cancer hasn't been proved. We don't have an entirely reliable way to assess if a tumor will be aggressive.

• The best we can do is monitor a patient's condition through the tests we have, such as PSA and rectal exams, and look for changes from year to year. There's no way to do that without regular screening.

• False positives do occur, but that's no reason not to screen. Intelligent use of the results and followup exams will avoid unnecessary testing.

• It would be ideal for doctors and patients to consult before screening, as the society suggests, but primary care doctors simply don't have the time during office visits to do this. Certainly, printed information should be given to patients, as the society suggests, and doctors should tell them there is controversy over screening, but just recommending extensive patient counseling won't make it happen.

• As for the idea that digital rectal exams aren't worth doing, patients should know that the purpose is to check for prostate size and nodules, which are then monitored in subsequent exams. Also, some rectal cancers can be found with this exam.

I have no objection to less frequent testing if an initial PSA at age 40 or 50 is less than 1.5, but others — especially high-risk groups such as African-Americans and those with a family history of prostate cancer — need them yearly.

For a fuller discussion of prostate cancer screening, please see my Jan. 30 column, which you'll find online at www.tampabay.com/news/health.

Dr. Sharkey is a prostate cancer educational consultant in Palm Harbor and was in full-time urological practice for 40 years. He can be reached at (727) 786-4531 or urologyhealth@yahoo.com.