Morning Rounds: When should men be screened for prostate cancer?

(CBS News) CBS News chief medical correspondent Dr. Jon LaPook and CBS News contributor Dr. David Agus joined "CBS This Morning: Saturday" to discuss the major medical story of the week.

An estimated 240,000 Americans are diagnosed with prostate cancer every year, and almost 30,000 die, making it the second-leading cause of cancer death for men.

Current screening guidelines say men over 50 can consider being tested for prostate cancer. However, screening is not recommended for men over the age of 75.

Many older men still getting PSA test for prostate cancer, against recommendations

A new report in the Journal of the American Medical Association (JAMA) said that as many as 40 percent of men over 75 are still being tested.

LaPook explained to the "CBS This Morning: Saturday" co-hosts that testing for prostate cancer is a confusing issue for both patients and doctors for a couple of reasons. First, the test used for this type of screening, called a prostate-specific antigen (PSA), is helpful but it is not always a good indicator of the disease and can create cause for false alarm. A rise in a PSA level can be prostate cancer, but it also rises with many other benign conditions, such as the prostate naturally getting bigger with age.

Also, he explained that even if PSA levels led to cancer being found, it might not be as urgent a situation as it is perceived.

"Even if you do have an elevated PSA and you get a prostate biopsy, and it shows prostate cancer, the odds are you're not going to die from prostate cancer because it's such a slow-growing thing. It usually takes at least 10 years to kill you," he said.

While there are exceptions to that, according to the National Cancer Institute 83 percent of prostate cancers are non-fatal and only about 3 percent of men die from this disease.

LaPook said that the big challenge was preventing those deaths at the same time as avoiding overtesting and overtreating for prostate cancer.

Agus said that is a complicated subject. He explained that since the United States started screening for prostate cancer the death rate from the disease has decreased by 45 percent, yet many overtreat it as well. He said that in his practice he tests all men as long as they have a five-year life expectancy, and he takes more care when advising for treatment.

"There are many patients that when we do a biopsy, and it's got a very low grade cancer that I know isn't going to cause a problem, which is about 40 to 45 percent, we don't treat," he said. "We follow them and do a repeat biopsy. We call that active surveillance."

Cancer specialist: Slow-growing cancers need to be redefined to reduce overtreament

Patients who are treated too aggressively for prostate cancer may experience many other problems. According to JAMA, some of the risks of overtreatment are impotence, erectile dysfunction, urinary incontinence and bowel problems. Agus explained that there's also the emotional toll of being told you have cancer.

"I think we need to change the words, so low-grade prostate cancer, take out that word cancer - let's just call it a low-grade prostate condition," he said. "Then you're going to take away all of that emotional stress."

For Dr. Jon LaPook and Dr. David Agus' full interview on prostate cancer screening, watch the video in the player above.

Check out more from Morning Rounds with Dr. LaPook

  • Shoshana Davis

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