To screen or not to screen - a matter of life or death

Dr Belinda F Morrison, Contributor

September is internationally recognised as Prostate Cancer Awareness Month. Annually, there are greater efforts by local, regional and international urological bodies and cancer societies to increase knowledge about prostate cancer.

The recommendation of the Jamaica Urological Society and the Jamaica Cancer Society is that all men should have annual screening for prostate cancer, beginning at age 40. Screening involves a physician performing the digital rectal examination (DRE) and the patient having a blood test done, checking for the protein, prostate-specific antigen (PSA). An abnormal DRE and/or an elevated PSA warrant a confirmatory prostate biopsy.

Treatment of diagnosed prostate cancer then follows and depends on the patient's age, disease stage and the patient's desires. The evidence of any effective public-health educational campaign for prostate cancer is manifested in an increased number of men presenting for screening, a stage migration (down-staging) of newly diagnosed prostate cancer, as well as improved understanding of the disease by men.

The recommendation for prostate cancer screening has been a controversial topic over the past few years. This was highlighted in October 2011 when the United States Preventative Task Force (USPTF) recommended against screening by stating that there is "moderate or high certainty that the service (PSA screening) has no benefit or that the harm outweighs the benefits." The USPTF, a group with non-urologist and non-oncologist members, made these recommendations based on their analysis of recently concluded screening trials. (Note that in these trials, men of African ethnicity were always under-represented).

The recommendation was indeed inappropriate based on the results of two large screening trials, where in the European arm, screening for prostate cancer resulted in 29 per cent fewer deaths from the disease. The American Urological Association (AUA) disagreed with USPTF and further stated that the recommendation was a disservice to men to deny them the opportunity for treatment and cure.

The AUA released adjusted guidelines regarding prostate-cancer screening at their recent meeting in May 2013 in San Diego, United States. Several Jamaican men have inquired about the adjusted guidelines.

Though the AUA has adjusted its guidelines for average-risk men in specific age groups, the recommendations for African-American men have remained the same. Men of African ethnicity or those with a family history are considered high risk for developing prostate cancer. These men still benefit from screening between the ages of 40-70 years.

In Jamaica, where more than 90 per cent of men are of African ancestry, prostate cancer screening must commence at age 40 years.

Why is screening so important for Jamaican men?

Prostate cancer remains the leading cause of cancer in Jamaica.

Jamaica is reported to have one of the highest death rates of prostate cancer in the world.

Jamaican men, based on race, are at high risk for developing prostate cancer.

Death rates from prostate cancer are reduced when widespread screening is introduced.

Though prostate cancer screening has been a controversial subject, the recommendations still stand for Jamaican men. I encourage all men 40 years and over to have a prostate exam this September! Let us help reduce the death rates from prostate cancer in Jamaica and improve men's health and quality of life.

Dr Belinda F Morrison is a lecturer and urologist at the University of the West Indies. Yourhealth@gleanerjm.com.