Despite actor Ben Stiller’s recommendation, many medical professionals are still skeptical about men undergoing a once common screening for prostate cancer.
This week, Stiller wrote an essay in which he stated the prostate specific antigen (PSA) test saved his life.
Two years ago, the star of such movies as “Night at the Museum” and “Meet the Fockers” was diagnosed with prostate cancer at the age of 46.
Stiller said he was diagnosed because “my internist gave me a test he didn’t have to.” The actor had no history of prostate cancer in his family, had no symptoms, and is not a member of a high-risk group.
Stiller was treated, and three months later he was cancer free.
“Taking the PSA test saved my life. Literally. That’s why I am writing this now,” Stiller said in his column. “There has been a lot of controversy over the test in the last few years. Articles and op-eds on whether it is safe, studies that seem to be interpreted in many different ways, and debates about whether men should take it all. I am not offering a scientific point of view here, just a personal one, based on my experience.”
Stiller says men over the age of 40 should discuss the PSA test with their doctors, weigh their options, and decide whether to be screened.
Despite Stiller’s personal testimonial, most medical organizations recommend men don’t get screened regularly for prostate cancer.
They say the test misses more cancer than it catches, can cause infections and other conditions, and can lead to unnecessary and expensive treatments.
“The other side of prostate cancer needs to be considered here,” Dr. Otis Brawley, the chief medical officer for the American Cancer Society, told Healthline.
Prostate cancer isn’t that deadly
The American Cancer Society estimates that 180,000 men in the United States will be diagnosed this year with prostate cancer.
Of them, about 26,000 will die from the disease. That makes prostate cancer the second leading cause of cancer death in U.S. men, behind lung cancer.
However, Brawley and other experts say prostate cancer is a slow growing cancer that often doesn’t go beyond an initial stage.
“Many times, the cancer just sits there and does not progress,” said Brawley.
Even in deadly cases, the disease can take 15 years or more to become fatal.
In fact, the 5-year survival rate for prostate cancer is almost 100 percent. The 10-year survival rate is estimated at 98 percent, and the 15-year survival rate is 95 percent.
Brawley said a study involving autopsies of men in their 90s who died of heart attacks showed that 80 percent of them had prostate cancer that was not a threat to their lives.
These statistics are one reason many men who are diagnosed with prostate cancer are taking a “watch and wait” attitude instead of immediately opting for treatment.
Brawley said that most men who die from prostate cancer have a form of the disease that will kill them no matter when they are diagnosed and what treatment they get.
Problems with tests, treatments
The PSA test used to be standard medical procedure for older men.
However, in 2012 the U.S. Preventive Services Task Force (USPSTF) recommended against the test.
That recommendation is now under review by task force members. Among other things, they say new technology may make the tests more accurate.
Nonetheless, USPSTF officials and others say the current PSA test produces too many false positives, especially in men under the age of 50.
In addition, they say those faulty results sometimes cause men to undergo painful biopsies.
Brawley said those biopsies can cause infections and even cardiovascular problems.
In some cases, the men have undergone cancer treatments when perhaps they didn’t need to.
“The reality is that many times that person’s life was never in danger,” said Brawley.
A study published last month in the New England Journal Medicine revealed that half the men with prostate cancer who took a “watch and wait” approach didn’t need any additional treatment.
It also concluded that whether the men were in the “wait” group or in a group that was treated, they were unlikely to die of prostate cancer within 10 years.
The USPSTF estimates that 5 in 1,000 men will die of prostate cancer without screening, while 4 in 1,000 will die of the disease after being screened.
That means 1 out of 1,000 men would be saved with screening.
The USPSTF, therefore, concluded “there is moderate certainty that the benefits of PSA-based screening for prostate cancer do not outweigh the harms.”
The American Cancer Society recommends that discussion about prostate cancer screenings should begin at age 50 for men who are at average risk of the disease.
Men under 50, the organization recommends, should consider screenings only if they have a higher than normal risk.