First time it really hits home how large the risk is.
1/6 is a rather large risk.
1/6 is a rather large risk.
Yes, cancer is never good but for most men prostate cancer develops late and is usually growing very slowly and doesn't spread.
Here are a bunch of slides of prostate samples. Find the cancerous one.
This led to the teacher getting so many questions about whether the slide someone was currently looking at was the cancerous one that he was forced to interrupt the class to make this more general announcement:
There's a bit of cancer in everyone's prostate. Find the slide with obvious cancer.
I would not expect a man in his late 20s to fall into the category "men of an advanced age". But I would be unsurprised to learn that there was visible protocancer in a sample of his prostate.
The question is whether your body sees and kills the cancer cells; most of the time it does, which is why most of us can live pleasantly for most of our lives despite errors cropping up silently. What we term cancer are the cancer cells that slipped past our body's defences, growing into masses that cause no end of grief.
To put it in computer terms, it's like error correction in HDDs and SSDs and ethernet connections. Errors are inevitably going to occur while data is in transit, but they are of no concern so long as error correction and other such mechanisms can correct and recover. The errors do become a concern when they start slipping past such mechanisms, however.
That is as much a philosophical question as it is biological, and one where the answer will vary by who is asked.
Personally, I will say this: If you're miserable while endeavouring to prevent cancer (or any other disease), that's putting the cart before the horse. The goal is, presumably after all, to live happily.
The above link mentions "one in eight men" will be affected by prostate cancer.
If you have the deadly fast-growing type of prostate cancer, it'll be evident soon enough.
https://www.marketwatch.com/story/good-news-and-bad-news-kid...
Doctors don't try to do the test on every man over 55 without a good reason.
Some guidelines suggest that it's reasonable to continue in patients with >10-15 year life expectancy if the patient desires, but there is no strong recommendation or evidence to support this recommendation or screening in this age group.
Some guidelines actually have a strong recommendation to stop screening men with < 15 year life expectancy.
Even less evidence for a DRE. PSA by a GP is sufficient if you desire screening.
I believe my father's prostate cancer was found via DRE and not PSA. That is, PSA was in the normal range. That is what made me get a DRE from a urologist once a year (since then).
PSA cutoff trades sensitivity and specificity. It isn’t a binary positive/negative.
There are certain highly aggressive but very rare subtypes (e.g. neuroendocrine) that will present with low PSA levels. Rarely an aggressive adenocarcinoma (Gleason 8+) will present with low PSA. Screen detected prostate cancers with low PSA are most likely clinically insignificant [0].
If you are known to have a first degree relative with a rare subtype then routine screening guidelines don’t apply to your circumstance.
Important points to keep in mind:
Just because a prostate cancer is “found” it doesn’t mean it needs to be treated.
There is no survival benefit when comparing treating early prostate adenocarcinoma (conventional and most common type representing 99% of prostate cancers) at very low PSA vs using 4ng/mL as a cutoff.
There are verifiable and proven harms with over treatment of low grade prostate cancer, workup of a “nodule” felt on DRE in the context of normal PSA is more likely to harm a patient than benefit them even if cancerous which forms the basis of current guidelines.
All forms of cancer screening will have edge cases that are missed. Even in your father’s case only the peripheral zone is palpable by DRE (would miss transitional zone or 20% of cancers). When considering recommendations to make at a population level harms vs benefits have to be carefully weighed, in the case of prostate the evidence strongly suggests against DRE, and weakly against prostate cancer screening in general.
Looking towards the future, there is probably a role for prostate MRI somewhere which is good at detecting clinically significant (Gleason 7+) cancers but this is still being actively studied and we don’t have enough evidence at this time to support screening.
[0] https://bjui-journals.onlinelibrary.wiley.com/doi/full/10.11...
There are an estimated 43,780 deaths attributable to breast cancer and 34,500 to prostate cancer in the US for 2022[0] and 5555 vs 4600 respectively in Canada. This is spite of aggressive screening and early treatment vs not really for prostate cancer.
Most of them are caused by lifestyle/environment: https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/t...
> Over one third of cancer deaths worldwide (and about 75–80% in the United States) are potentially avoidable by reducing exposure to known factors.
> Common environmental factors that contribute to cancer death include exposure to different chemical and physical agents (tobacco use accounts for 25–30% of cancer deaths), environmental pollutants, diet and obesity (30–35%), infections (15–20%), and radiation (both ionizing and non-ionizing, up to 10%).
> less than 0.3% of the population are carriers of a cancer-related genetic mutation and these make up less than 3–10% of all cancer cases.