Prostate cancer is one of the most common cancers affecting men. But there’s confusion: When should men be screened, which tests are reliable, and what trade‑offs do they carry? In a recent Guardian article, Dr. Clifford Gluck spoke out about both the advantages and drawbacks of prostate cancer screening. As a patient, knowing what’s involved helps you take control of your health—and get screened on your terms.
What Are the Screening Options?
- PSA (Prostate‑Specific Antigen) blood test: Measures levels of a protein produced by the prostate. Elevated levels can be a warning sign—but many causes (including non‑cancerous ones like infection or BPH) can raise PSA.
- Digital Rectal Exam (DRE): A physical check of the prostate via the rectum to feel for lumps or irregularities.
- Imaging & Biopsy: If PSA or DRE raise concerns, doctors may order MRI scans or perform a biopsy to confirm or rule out cancer.
What Dr. Gluck Emphasizes: The Pros of Screening
- Early detection is critical — Finding prostate cancer early often means more treatment options and better outcomes. When caught before it spreads beyond the prostate, success, cure, or effective management are much more likely.
- Slower progress of disease in earlier stages — Prostate cancer frequently progresses slowly; catching it earlier helps prevent it from becoming aggressive or metastasizing.
- Newer treatments reduce side‑effects — Thanks to advances like HIFU (High Intensity Focused Ultrasound), many of the historical downsides (severe incontinence or erectile dysfunction) can now be minimized. These newer options make screening a more favorable decision in many cases.
What Are the Risks & Downsides?
Screening is not without trade‑offs. Dr. Gluck (and many experts quoted in The Guardian article) note:
- False positives & false negatives: PSA may flag something that isn’t cancer, leading to anxiety, additional tests, or treatment that may have been unnecessary. Conversely, PSA may miss some cancers.
- Overdiagnosis: Some cancers detected would never have caused harm if they’d remained undetected. Treating them can cause more harm than letting them be.
- Side effects from treatment: Even earlier‑stage treatments (surgery, radiation) have risks — urinary incontinence, erectile dysfunction, etc. These risks historically led many to hesitate. But Dr. Gluck argues treatments have improved a lot.
When Should You Start Screening?
Here’s Dr. Gluck’s guidance, based on current evidence and expert opinion:
| Your Risk Factors | When to Start PSA / Screening |
|---|---|
| General male population with no risk factors | Age 50 annually |
| Family history of prostate cancer; African American men or men with genetic risk | Age 40–45 or earlier, based on discussion |
| If PSA changes significantly year over year (for example, a rise of ~0.75 ng/mL or more) | Seek evaluation sooner; discuss with urologist |
Also, keep in mind:
- Screening decisions are personal. Discuss your values: Do you prefer more aggressive detection or are you more concerned about avoiding side effects?
- Imaging (like MRI) or newer non‑invasive treatments can help reduce harms for many men.
What Advances Are Changing the Picture
Dr. Gluck points out that newer technologies like HIFU are game-changers:
- Less invasive: HIFU uses focused ultrasound energy to destroy cancerous tissues without cutting.
- Lower risk of complications: Much lower risk of erectile dysfunction or incontinence compared to traditional surgery or radiation in many cases.
- Outpatient, faster recovery: Many patients recover more quickly, with fewer long-term side effects.
These advances shift the balance for many men toward early screening being more beneficial than it may have seemed in years past.
What to Ask Your Doctor
When you plan your screening, here are key questions to bring up:
- Based on my age, family history, ancestry, and health, do I need PSA screening now?
- What is my baseline PSA, and do we plan to track it over time?
- If PSA is high, what’s the next step — imaging, biopsy, etc.?
- What treatment options are available here (local to the South Shore), especially newer ones like HIFU?
- What are the possible side effects, and how likely are they in my case?
| Myth | Reality |
|---|---|
| “If PSA is under 4, I’m safe.” | Not always. Rate of increase matters. A jump year‑to‑year can be more telling. |
| “Screening causes more harm than good.” | This was true in older eras. But with improving treatments and imaging, many harms can be reduced. |
| “Only those with symptoms should get checked.” | Many men have no symptoms early on. That’s when detection can make the biggest difference. |
Conclusion
Screening for prostate cancer is not one‑size‑fits‑all. It comes with real benefits – earlier detection, more treatment options, and potential for cure – but also with risks like over diagnosis, unnecessary treatment, and side effects. What Dr. Gluck emphasizes is that with advances like HIFU, better imaging, and improved treatment techniques, the decision is now more favorable for many men than in the past.
If you’re over 50 (or younger with risk factors), talk to your urologist about having a baseline PSA, regular monitoring, and what modern treatment options you’d be comfortable with. It’s your health, your decision. And knowing the facts matters more than anything.
FAQ
Q: Does every man need a PSA test?
A: Not necessarily. It depends on age, overall health, family history, and risk factors. Some men may choose to delay or decline screening after understanding benefits vs. risks.
Q: Can a normal PSA level guarantee there’s no cancer?
A: No. Some cancers don’t raise PSA. That’s why rate of change and other diagnostics (MRI, biopsy) can be important.
Q: Is HIFU widely available, and is it better than surgery or radiation?
A: HIFU is increasingly available in specialized centers. For localized prostate cancer in the right patient, it often offers similar success with fewer long‑term side effects.