An MRI scan could improve the accuracy of prostate cancer screening
There are both positive and negative aspects to consider when it comes to prostate cancer screening. Let’s start with the negative news: the blood test used, which measures a compound called prostate-specific antigen (PSA), is not very accurate. This means that some men may undergo unnecessary cancer treatments, which can lead to incontinence and erectile dysfunction.
However, there is a potential solution to improve the accuracy of screening. By combining the PSA test with an MRI scan of the prostate, the screening process could become more reliable, especially if this dual test is recommended only for those at high risk of developing the tumor. The Lancet Commission on Prostate Cancer, a group of experts, has made this recommendation in a recent report.
It is clear that a reevaluation of prostate screening is necessary. But the question remains: will these new proposals effectively reduce the negative consequences?
Prostate screening has always been a topic of controversy. Although PSA levels are elevated in cancerous prostate cells, they can also be produced at lower levels by healthy cells.
The blood test was initially introduced as a means to monitor the success of cancer treatment. It later started being used as a screening tool in the 1990s, partly due to advocacy from men’s health groups who wanted an equivalent to breast cancer screenings.
The problem lies in the fact that PSA alone is not a reliable screening tool. Levels can temporarily increase after sexual activity, during a urinary tract infection, or even after a bike ride. Even if the increase is persistent, most prostate cancers grow so slowly that they would never have been detected or caused any issues if left untreated.
These concerns would be less significant if it weren’t for the fact that the treatments used to remove the cancer, such as surgery or radioactive pellets, often result in permanent incontinence or erectile dysfunction. Even a biopsy to determine the presence of cancer can lead to these complications.
Randomized trials have shown that out of every 1000 men who undergo regular PSA screening, there is one less death from prostate cancer over a span of 10 years. However, three men are left with incontinence and 25 with impotence.
These statistics highlight the discomforting consequences that can arise from prostate cancer screening.
