Prostate- cancer screening a safe and inexpensive test

: Every article I have read about prostate screening fails to define “screening.”

I had thought of screening as the PSA blood test and/or the digital exam. But because I have read that the screening can possibly be harmful, it must consist of more than I had in mind.

I would appreciate an explanation.

A screening test is one that is done to diagnose a condition in someone who has no symptoms of the condition. Strictly speaking, much of gathering your medical history involves asking screening questions (such as, “Do you have any shortness of breath?”); the physical exam often qualifies as a screening test; and there are many blood and radiology tests that are used to screen.

A good screening test is safe and inexpensive. A condition appropriate for screening is one that is common enough to make screening worthwhile, serious enough to matter and has better outcomes if treated early, compared with treating after symptoms develop.

For prostate cancer in particular, the screening tests themselves aren’t the problem: A tube of blood or a physical exam may be unpleasant, but not really harmful.

The harm can come when the screening test turns positive.

An abnormal PSA test often leads to a biopsy, which can occasionally cause harm.

Then again, the real harm comes after the biopsy, when cancer can be diagnosed.

Some cancers are very indolent, meaning they grow slowly and are unlikely to cause problems in the foreseeable future. Some men wish to remove any type of cancer, no matter how small the risk of growth, and instead will choose to undergo treatment rather than take a wait-and-see approach.

It is these treatments — usually surgery or radiation — that have the potential for harm, as many men develop side effects that impair their quality of life, especially sexual side effects and incontinence of urine.

There are two ways to avoid possible harm from a screening test: Don’t do one (which some groups recommend when it comes to prostate cancer screening), or do the test only if you are prepared to be rational about the findings.

That means you can get the benefit of possibly finding and treating an aggressive cancer early, but can avoid unnecessary treatment for a low-risk or verylow-risk tumor.

It isn’t always easy to be rational about these choices, so it’s important to know ahead of time what the possibilities are.

— R.G.