Prostate exams may benefit older men

Dear Dr. Roach: I am a 66-year-old male. Part of my annual physical for as long as I can remember included a prostate exam. I now have a young, new doctor and at my recent physical, he did not give me a prostate exam. I’ve always thought that a prostate exam was very important for someone my age. Should I be concerned? — T.A.

The prostate exam remains controversial. Even though the prostate exam is no longer recommended by many authorities, I still think you may be right to be concerned.

Prostate cancer is a common condition affecting men in their 60s (it’s very uncommon below age 50), and becomes even more common in the 70s and older. Prostate cancer is a whole spectrum of illness, ranging from very aggressive cancers that spread rapidly, to very indolent cancers that will never cause problems. In general, younger men are more likely to have the rare, aggressive cancers, and older men are more likely to have more indolent cancers.

Age 66 is a time when prostate cancer is not uncommon, so it is worthwhile discussing screening for cancer, with a PSA blood test.

I would have hoped your new doctor would have discussed the benefits and risks of screening. You should have heard that the PSA test may find cancer, but much of the time, the cancer has a low risk for progressing, and is watched carefully rather than treated immediately because treatment of low-risk cancer causes more harm than good. The goal of prostate cancer screening is to find the unusual case of a high-risk prostate cancer, which is treated aggressively. Although the evidence is mixed, I believe that lives can be saved with screening, and if men receive proper counseling about NOT treating low-risk cancer, unnecessary procedures can be minimized.