Prostate cancer screening has risks
Dear Dr. Roach: My husband, who is paralyzed on the left side from a stroke suffered eight years ago, underwent a prostate biopsy five years ago. The biopsy released E. coli into his bloodstream, resulting in several days of hospitalization with sepsis, and several weeks of rehab in a nursing centre, where he contracted MRSA — methicillin-resistant Staphylococcus aureus. Now his doctor is recommending another prostate biopsy because of elevated prostate levels. I am reluctant to put him through this again. What are the pros and cons? F.O.
Prostate cancer screening — looking for cancer in someone who doesn’t have any symptoms of the disease — is a reasonable consideration for healthy men between the ages of 50 and 70, but the guidelines are controversial. Although there may be a small benefit in reduction of prostate cancer, there is also a small risk of harm. Your husband is an example of the harm that can come from getting a screening test, as it can lead to procedures that have unwanted sideeffects or complications.
The U.S. Preventive Services Task Force has reviewed the data and recommends against prostate cancer screening, as the evidence suggests that more men are harmed by it than are helped.
In men with a higher risk of prostate cancer, such as black men or those with a family history, there is more likely to be a benefit.
For men who have other serious health conditions, the balance of benefit and harm tilts toward net harm. I don’t know whether your husband was given the opportunity to reflect on the risks and benefits of prostate cancer screening five years ago, but given the situation now, I would be very reluctant to recommend prostate screening.
However, he apparently has already had the screening and is now recommended for biopsy. He still has a risk from the biopsy, but more importantly, if the biopsy shows cancer, it isn’t clear that treatment will increase his length of life, and it is likely that his quality of life would worsen with treatment.
The bottom line: Getting the PSA test does not obligate him to get a biopsy, and a biopsy result showing cancer does not obligate him to be treated. Many prostate cancers, especially those found by screening, are not aggressive, and waiting until any symptoms develop is a reasonable option for any man -- and, in my opinion, probably the best option for a man with significant health issues like your husband.
I hope this helps guide the conversation between your husband and his doctor.
Dear Dr. Roach: I have colon cancer in my family (my grandfather and his only sibling). I have lost 20 pounds in eight months, and I feel nauseated and bloated. I had a colonoscopy seven years ago, with no problems.
My husband says there is no way I could have cancer now, because my previous colonoscopy was OK, so I should wait three more years. What is your opinion?
A.D. It is absolutely appropriate for you to get evaluated for your symptoms. I don’t know whether they represent cancer, but weight loss of this degree is very concerning. I suspect your doctor will want to perform another colonoscopy.
Unfortunately, colon cancer could go from undetectable to advanced in as little as seven years. More importantly, even though a colonoscopy is probably the best screening test we have for cancer, it isn’t perfect, and even the best practitioner can miss a polyp.
It might be appropriate to have a screening colonoscopy every 10 years if the previous exam was completely normal, but you have symptoms, which means this isn’t screening — it’s an evaluation of your symptoms.