Indeed, the number of men being diagnosed with prostate cancer is on the rise. In the United States, prostate cancer is now the most common form of cancer and the second most common cause of cancer death in men. More than 230,000 Americans are predicted to be diagnosed with the disease this year. In the Philippines, prostate cancer is already among the top five most common forms of cancer in men. In all likelihood, the disease will steadily climb to the top of the disease ladder with time.

The seeming rise in incidence of prostate cancer has really nothing to do with a difference in diet or lifestyle of today’s males compared to those who lived decades ago. It is actually due to the fact that more men are now undergoing the screening procedures designed to detect the presence of prostate cancer. These two screening procedures are PSA testing and digital rectal examination. The former is a blood test that measures prostate specific antigen (PSA) while the latter is an examination conducted by a physician and involves feeling for the size and abnormalities in the prostate through the rectal wall by inserting a rubber-gloved finger through the anus.

The prostate is one of several accessory glands of the male reproductive system. Its secretion forms part of semen. It lies underneath the urinary bladder and it surrounds part of the urethra, the tube that empties urine from the bladder. Normally, it is about 4 x 3 x 2 cm in size.

Prostate cancer is a very slow growing malignancy. Often, it persists for years without producing any symptom. In fact, prior to the introduction of PSA testing, most men with prostate cancer outlived their disease and died from other causes without even knowing they had the cancer. But lately, however, more and more physicians (like your company physician) have been advising their male patients to undergo PSA testing, even if they have no symptoms. Consequently, whereas before, prostate cancer often goes undetected till death, it is now often diagnosed early in its course. This — more than an actual increase in the incidence of the disease — has accounted for the seeming surge in incidence of prostate cancer all over the world.

At present, experts disagree on whether routine screening for prostate cancer helps at all. On the one hand, it allows for early detection, and possible cure, of the disease. On the other hand, treating a very slow growing prostate cancer may be more damaging than leaving it untreated. Surgery and radiation treatment, the current treatment modalities for prostate cancer, can cause long-term adverse effects such as urinary incontinence and impotence. Besides, the PSA test is not diagnostic of prostate cancer. The PSA level gets elevated not just in the presence of prostate cancer but in a variety of other conditions such as benign prostatic hypertrophy. Sometimes, it does not go up even if there is cancer. At most, a high PSA level only indicates the possibility of cancer, which necessarily implies more expensive, invasive, and sometimes harmful, tests.

Results of many scientific studies have shown that PSA testing and digital rectal examination have not been effective in saving lives. In a recent study which was published in the Archives of Internal Medicine (a reputable medical journal), for example, researchers compared two groups of men treated at ten Veterans Affairs Medical Center from 1991 through 1999. One group consisted of 501 men who were diagnosed with prostate cancer and later died of that disease or other causes. Another group consisted of 501 men who matched the first group for age and other factors, but who remained alive. Results of the study showed that the men who were alive were no more likely to have been screened than the men who died of prostate cancer. The findings support an earlier review by the US Preventive Services Task Force, which said in 2002 that it found "insufficient evidence" for a recommendation that men be screened for prostate cancer. This study and those conducted before it are however not conclusive because of the small number of their sample population. Nonetheless, there is an ongoing study which may give a definitive answer to this issue. This ongoing study has 300,000 US and European men as subjects, but it will be completed in 2009.

Experts differ on their screening recommendations for prostate cancer. The American Cancer Society says men starting at age 50 should be informed of the risks and benefits of screening, then make their own decisions, but higher-risk men, including African-Americans, should be screened annually starting at age 45.

Should you, therefore, undergo PSA testing? That’s up to you.

Address inquiries on health matters to Dr. Eduardo G. Gonzales, DLSU College of Medicine, Dasmariñas, Cavite 4114.