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Pros and Cons of Screening for Prostate Cancer

Thursday, April 25, 2013 at 7:30 AM

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Larry Reed, East Cleveland.

The Cleveland Clinic’s Minority Men’s Health Fair gets underway on Thursday April 25th. This well-attended fair is in its 11th year running and offers free screenings for things like diabetes, sleep apnea, high cholesterol, and sickle cell disease. One of the featured screenings is for a disease that’s gotten a lot of press over the last year: prostate cancer. Many experts disagree about the value of screening for this type of cancer. Health reporter Anne Glausser has more.

Larry Reed, from East Cleveland, knew he should get a checkup. 

But he sort of dragged his feet on it for nearly a decade. 

REED:  I always thought, if nothing’s hurting, I’m ok.

Then he heard about the Cleveland Clinic Minority Men’s Health Fair and thought he’d give it a shot. 

When he got there, he was a bit overwhelmed.

REED:  It was like, oh wow, I’ll never get through this evening, and what are the areas I want to stop and get screened in?  And I knew one of them was going to be the prostate. 

Dr. Charles Modlin is the force behind the fair:  he runs the Clinic’s Minority Men’s Health Center. 

He says it’s important for all men, but especially black men like Larry Reed, to get screened for prostate cancer.

MODLIN:  The death rate, mortality rate, is twice as high, in black men.

Researchers aren’t sure why this is; genetics may be a factor. 

Modlin says early detection is crucial.

MODLIN:  Prostate cancer is potentially curable if detected in early stages.

So it seems like it’d be an easy decision to get screened.

But last May the U.S. Preventive Services Task Force made a splash when it recommended against getting the screening, through a blood test called the PSA.

LEFEVRE:  The benefits are very small, the harms are substantial and the probability that a man will live longer or better because of screening is remote.  So we recommend against it.

Dr. Michael LeFevre is a member of the Task Force. 

This group of independent doctors reviewed the science and concluded the blood test isn’t worth getting. 

That’s a hard message to sell, but here’s the thing: most prostate cancers are slow-growing and not likely to cause harm during a man’s lifetime. 

Primary care doc Michael Barry from Mass General Hospital in Boston explains the potential harms that could come of screening and follow-up care:

BARRY:  And the harm would come through the small but finite risks of the biopsy—infection, bleeding—and the anxiety around now having a cancer diagnosis even though it’s a cancer diagnosis that wouldn’t have mattered, and then if we feel obliged to treat them with radiation or surgery, surgery has a small but finite risk of dying, and both procedures can lead to problems like incontinence and sexual dysfunction.

Lefevre, from the Task Force, says they specifically recommend against getting screened for prostate cancer in a health fair setting because it doesn’t offer men the chance for a one-on-one conversation with a doc.

LEFEVRE: We don’t think that mass screenings are in fact a way for a man to make an informed choice about whether screening is a good thing to do or not. And we believe that employer-based screens, as well as community fairs, should be stopped. 

The Clinic’s Dr. Modlin says the fair is an important chance to reach people who are at higher risk of aggressive prostate cancer. 

Many men come in after years of avoiding the doctor’s office.

For Clevelander Larry Reed, the screening detected the early stages of prostate cancer.

Whether or not that cancer would have ever caused him problems, isn’t clear. 

It’s hard for doctors to distinguish between the slow-growing majority of prostate cancers and the smaller percent of more aggressive, deadly ones. 

Dr. Modlin laid out all the treatment options for Reed—including something called “watchful waiting” or “active surveillance” of the prostate--but Reid decided he wanted it OUT.

REED:  So I just said, hey, if I can live without it, then good riddance.

Reed is grateful his cancer was detected & removed, and says the side-effects haven’t been too bad.

If you’re looking for some guidance on whether to get yourself screened, the best approach may be to educate yourself and talk to a doctor you trust.

Additional Information

American Cancer Society Guidelines for the Early Detection of Cancer

African American Men and Prostate Cancer: Be Your Own Advocate and Understand Screening

CDC:  Prostate Cancer Screening

To Screen Or Not?

Questioning Surgery for Early Prostate Cancer

The Prostate Cancer Quandary

Prostate Chronicles from ideastream’s David C. Barnett

Prostate cancer is just one of the many free health screenings that will be offered at the Minority Men’s Health Fair Thursday April 25th from 5:30-8:30pm at the Cleveland Clinic. 

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