Prostate Cancer Screening – Where are we?

Many men who have been going to the doctor for years remember the annual digital rectal exam for prostate cancer screening.  I was taught this in medical school in 2011, before it started falling out of favor.  I often wondered how many men chose not to come to the doctor because they did not want this exam.  This screening test was replaced by the blood test PSA, or “prostate specific antigen.”

Many things in medicine have swung back and forth like pendulums.  Unfortunately, guidelines and recommendations often translate into medical dogmas: “You must do this…”  or “Never do this.”  The reality is that we live in between these dogmas, and individualized decision-making is quite nuanced.

In the past, prostate cancer screening had a feeling of “You must do this.”  More recently, the pendulum has swung to the opposite side, where many primary care physicians are reluctant to offer prostate cancer screenings.  Where should we be?

I have the answer: Shared decision-making.  The American Urological Association correctly identifies this as the starting point.  This looks like the following (taken from the AUA):  

1. Involvement of patient and clinician

2. Sharing of information from patient and clinician

3. Consensus building through expression of preference from patient and clinician

4. Agreement by both patient and clinician on decision

This is the framework for the nuances of the real world to live.  This requires trust and time with your primary care physician.