OncoLink

Early Detection and Screening for Prostate Cancer

Early Detection and Screening for Prostate Cancer

Question
Dear OncoLink "Ask the Experts,"
I lost my husband in February of 1997 to prostate cancer. In April of 1995, he went to his doctor complaining of increased frequency of urination. The doctor did a PSA test and a digital rectal examination. The PSA test was 3.3. The doctor told my husband that he was fine. In December of 1997, he went for his annual physical and blood work. His PSA was 57.9! His cancer was found to already be in his bones. He went through chemotherapy, radiation therapy, and basically every other form of treatment possible. He died 13 months later at the age of 57.

It really bothers me when I see these reports about prostate cancer that talk about "watchful waiting". My husband never had a chance. He was a very health-conscious man. As far as we know, there was not anyone in his family that had had prostate cancer. We have two sons, ages 26 & 23. They are already getting check-ups for prostate cancer. Is there anything else they can do?

I feel my husband was misdiagnosed originally, and I am angry about that. I had planned to spend the rest of my life with him, and now I am alone. We were married just shy of 26 years.
Thank you for listening but I would love to hear from someone.
C.G.


Answer
Neha Vapiwala, MD, Senior Editor for Oncolink, responds:

Dear C.G.
Thank you for your interest and question.

I am truly sorry to hear about your husband. Unfortunately, with all of the advances we have made, we still are not able to "cure" the vast majority of metastatic malignancies.

Watchful waiting is generally only considered to be appropriate in a prostate cancer patient whose life span is already limited by other serious diseases, such as heart or lung disease, advanced diabetes, other more aggressive cancers, dialysis, etc. This stems partly from a Scandinavian study that demonstrated the feasibility of a "watch and wait" approach in older patients with early-stage prostate cancer.

Annual follow-up for a normal PSA is accepted as routine practice. Of course, if the PSA or the digital rectal exam were abnormal, one would repeat the PSA testing sooner or perhaps obtain a prostate biopsy. However, with a normal PSA level and a negative digital rectal exam, most physicians would not investigate any further for prostate cancer because the odds of finding cancer are exceedingly low, and doing so would subject patients to unnecessary invasive procedures.

Ultimately, prostate cancer screening is far from perfect. Not all prostate cancers make the PSA levels rise above the "normal" range, just like not all PSA levels above the normal range represent cancer. On top of this, laboratory errors can occur. Despite the best efforts of physicians, prostate cancer can be disguised and progress rapidly, particularly in younger patients.

As for prevention or early detection for your sons, a more aggressive screening regimen is probably the most critical factor for men with a family history of prostate cancer in a first-degree relative. This should consist of regular digital rectal examinations on an annual basis (again, if normal, otherwise more frequently) starting at the age of 35 to 40 years old. Annual serum PSA tests should also begin about the same time. Having said this, there is no real consensus on when it is best to begin screening for patients with a family history. There are also no further screening mechanisms that are warranted unless an abnormality is found on the above mentioned tests.

Please see our section on prostate cancer screening.