For many diseases, it's common knowledge that screenings and early detection are vital for cancer survival rates. In recent years, however, prostate cancer screenings have been a source of contention for many health experts.

In 2011, the U.S. Preventive Services Task Force changed its prostate cancer screening guidelines, in effect, recommending that men not undergo the prostate-specific antigen, or PSA, test.


The test measures levels of prostate-specific antigen, a protein produced by the prostate. It's been found that there's a correlation between elevated levels of PSA and prostate cancer; however, many conditions may cause an elevated PSA.

According to the USPSTF, the harms of false positive prostate cancer diagnoses outweigh the potential for death from the disease.

In contrast to the USPSTF recommendations, the American Cancer Society recommends people who are at average risk of prostate cancer begin getting checked annually at age 50, while men who are at a higher risk — including African-Americans and those with a first-degree relative diagnosed with prostate cancer before 65 — begin getting checked at 40 or 45.

Prostate cancer and the PSA test have been thrust into the national spotlight in the past week as actor and comedian Ben Stiller appeared on Howard Stern's satellite radio show to discuss Stiller's recent diagnosis of prostate cancer.

In a piece self-published on Medium, Stiller wrote that the PSA test saved his life. He was first administered the test at 46, four years before even the ACA's recommended screening, and underwent surgery at 48, again a full two years before screening is recommended.

Thomas Galvin III, internal medicine specialist of the Carroll Health Group Primary Care, said one of the challenges in diagnosing and helping those with prostate cancer is that screening recommendations are not uniform among the various cancer societies.

According to the USPSTF, studies suggest that less than one man in 1,000 avoids death from prostate cancer because of screening, with many studies showing no benefit at all. Risks of screening include false positives, which can result in expensive, unnecessary tests and procedures such as biopsies, radiation and hormone therapy.

The task force said many undergo these procedures, despite the fact it is unlikely their cancer would have ever grown or caused health problems. Side effects from unnecessary treatment include erectile dysfunction, urinary incontinence, problems with bowel control and death from complications of surgery.

Galvin said, personally, he believes men between ages 50 and 75 who are expected to live at least 10 more years should have their PSA checked regularly, but consider their treatment options very carefully.

"Just because you have a diagnosis of prostate cancer doesn't mean it needs to be treated," Galvin said.

When a PSA comes back positive or above normal, Galvin said, it often makes sense to wait and see and then to test it again to make sure the raise is consistent.

"Sometimes when it comes back a little bit above normal, you have to check to see if it's still moving up," Galvin said. "We can repeat the test in six months, and if it's gone down, it's something we don't need to worry about. Sometimes it's flat-lined, and sometimes it bumps up."

Galvin said the morbidity of prostate cancer has dropped in recent years. He said surgery to remove the prostate used to be difficult, as it's located in a small and sensitive area. Now, with robotic technologies, it's much easier to do, according to Galvin.

"You don't have to get your hands in there, and there are a lot of advances that help you keep treating it," Galvin said. "What is important is a considered approach. You've got to talk to the patient."