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Powerful Choices Podcast: Prostate Cancer Testing

June 2009

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Colleen: Hello and welcome to the American Cancer Society’s Powerful Choices Podcast series, where you'll get the information you need to make everyday choices that can help you be well and stay well. I’m Colleen Doyle, the American Cancer Society’s director of nutrition and physical activity. Thanks so much for joining us.

I'm here today with Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, to talk about prostate cancer screening. The American Cancer Society is one of many organizations that do not recommend routine screening for prostate cancer.

Len, prostate cancer is the most common cancer among men in the United States, so why is there a debate about whether men should be tested for it?

Len: Thanks, Colleen, there's a debate because we still don't know for sure whether prostate cancer screening actually saves lives. Doctors had hoped to get some better answers to that question from two large studies being done in the United States and in Europe. But the early results from those studies, which were published a few months ago, still weren't clear.

The US study showed no real difference in prostate cancer deaths between men who got screened and those who didn't. The European study showed a small benefit, but it also found that overtreatment is a big problem in prostate cancer.

Colleen: When you say "overtreatment, what do you mean by that and why is it a problem?

Len: Overtreatment means a lot of men are getting treated for prostate cancer when they don't need to be. When we think about cancer, we generally think in terms of getting rid of it – treating it. But with prostate cancer, treatment is a little different. Some prostate cancers grow very quickly, and finding those earlier and treating them does improve a man's chances of survival. But many prostate cancers grow so slowly that they would never cause a man any problems at all, so treatment isn't really necessary.

Prostate cancer screening is done with a PSA blood test. It is very good at finding prostate cancer. But right now there aren't very good ways to know for sure how dangerous that cancer is, so most men diagnosed with prostate cancer are going to get treated – whether they need it or not.

Colleen: Why is treatment a problem?

Len: Treatments for prostate cancer can have a lot of unpleasant side effects like incontinence and impotence that really affect the quality of a man's life. For men with aggressive disease that might kill them, the risk of these side effects is worth the benefit of getting rid of the cancer. But that trade-off isn't as obvious for men whose disease would never have caused them any problems. So until we have a better way of figuring out which prostate cancers are dangerous, there will be a lot of men suffering from prostate cancer treatment side effects who didn't really need to.

Colleen: So what does the American Cancer Society recommend for prostate cancer screening?

Len: The American Cancer Society does not recommend routine screening at this time. Instead, men need to have a conversation with their doctor about the pros and cons of screening, and then decide whether they want to be tested or not. Men at average risk should have this talk starting at age 50. Men at higher risk should start earlier, at age 45. Men at higher risk include African American men and those with a family history of prostate cancer. If several men in your family developed prostate cancer before age 65, you should have the conversation about screening with your doctor as early as age 40.

Colleen: Thanks, Len. That's great information; I'm sure it will help lots of men make more-informed choices about their health. To learn more about prostate cancer, call us anytime at 1-800-227-2345 or visit us online at cancer.org. From all of us here at the American Cancer Society, thanks for watching.