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Prostate Exam: Should All Men Get a Prostate Cancer Screening?


Prostate exam - Dr. Axe

Prostate health is of the utmost importance for men, particularly men over the age of 40. In fact, according to the American Cancer Society (ACS), prostate cancer is second most common cancer in American men, trailing only skin cancer. (1) This is why so many men are encouraged to get a prostate exam, but recent research calls into question just how effective prostate exam screening is.

So what does the science say about prostate exam results? That’s the tricky part. The research out there is conflicting and has its issues, with one high-profile study concluding prostate exams do little to reduce prostate cancer mortality, while another found significant evidence that a prostate exam does, in fact, help reduce the mortality rate.

What gives? Let’s take a look.

The Prostate Exam Controversy

Widespread prostate exam screening in the late 1980s and continues today, but, as the Annals of Internal Medicine notes, it wasn’t until 2009 that seemingly strong research on prostate exam effectiveness was published in the New England Journal of Medicine. Examining two different studies, the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO) and European Randomized Study of Screening for Prostate Cancer (ERSPC), researchers found conflicting, contradictory results: (2)

The PLCO found low rates of prostate cancer death that did not differ significantly between groups, whereas the ERSPC suggested that screening reduced prostate cancer mortality by 20%.

From 1993 to 2001, the PLCO trial randomized men to either receive prostate exam screening or the control. What researchers found during the trial and in the subsequent 15-year follow-up is there were 255 deaths for those who were mandated to receive prostate exams and 244 deaths in the control group. This led to concluding: (3)

Extended follow-up of the PLCO trial over a median of 15 years continues to indicate nor eduction in prostate cancer mortality for the intervention arm versus the control arm. Because of the high rate of control-arm PSA testing, this finding can be viewed as showing no benefit of organized screening versus opportunistic screening.

However, the results aren’t so cut and dry.

In the ERSPC trial, screening was found to reduce the risk of prostate cancer death per year by 7 percent to 9 percent, and further analyses of both the ERSPC and PLCO led researchers to conclude that those receiving prostate exam screening reduced the risk of prostate cancer death by 25 percent to 31 percent in the ERSPC trial and 27 percent to 32 percent in the PLCO group. (4)

You read that correctly. Analysts actually found that the PLCO’s own findings were inaccurate and that prostate exam screening does, in fact, help lower prostate cancer mortality rates. But the case doesn’t end there. According to experts interviewed by Scientific American, the analyses published in the Annals of Internal Medicine used a method that ‘was ‘on shaky ground’ and used a ‘completely unverifiable’ methodology that they had ‘never seen before.’” (5)

Complicating matters even further, while prostate exam screening can help certain men, it can do little for others. For example, even more “men will be told they have cancer when in fact their abnormal cells would never grow, spread, or harm them.” Overdiagnosis can lead to unnecessary surgery and possible difficult-to-live-with side effects (such as incontinence), and in the end, not saving many lives.

The waters only get muddier when looking at the PLCO trial itself, which did not separate men who had prostate exam screenings from those who didn’t. Instead, the control group was only not mandated to get prostate exams, and many in the control group did receive screenings. Talk about a mess.

When it all boils down, it appears both studies and even the further analyses were flawed in both execution and actual data. This is problematic given that, according to the ACS, it’s estimated there will be more than 161,000 new cases of prostate cancer in the U.S. and nearly 27,000 prostate cancer deaths in 2017. Furthermore, about one in seven men will be diagnosed with prostate cancer during his lifetime.

So, Should All Men Get a Prostate Exam Screening?

At this point, it’s actually recommended that each individual talks with his doctor to assess the pros and cons of prostate exam screening. In an ideal world, everyone would get screened and diagnosed correctly, though the data bears out this isn’t always the case. Overdiagnoses appear to be a major issue, along with the actual effectiveness of prostate exams themselves.

It certainly can help with early detection in order to start treating prostate cancer sooner rather than later, and it’s always a good idea to have regular physical exams with a medical professional. However, there are other ways you can ensure your prostate health remains in top working order.

For instance, you can help decrease your risk for prostate cancer and improve prostate health through diet and lifestyle changes. Consume tomatoes, wild-caught fish, green tea and pumpkin seeds; avoid overconsuming meat and dairy, and exercise.

In addition, supplements like vitamin E and D, selenium, lycopene, zinc, fish oil, saw palmetto, and stinging nettle can help, in addition to essential oils like rosemary, frankincense and myrrh.

Final Thoughts

  • According to the American Cancer Society (ACS), prostate cancer is second most common cancer in American men.
  • About one in seven men will be diagnosed with prostate cancer during his lifetime.
  • Prostate exam screening has been done since the 1980s, but its effectiveness wasn’t truly examined until research results were published in 2009. Those results were surprising: According to the PLCO, screening did not result in any significant impact in reducing prostate cancer death.
  • However, later analyses of the PLCO trial and the ERSPC trial found a significant reduction in prostate cancer mortality due to prostate exam screening.
  • Further complicating matters, both sets of data and methodologies have been called into questions by experts, resulting in an array of confusion. Overdiagnoses also make things difficult, as it appears there are more significantly more men diagnosed after screenings than are actually saved by screenings.
  • It’s best to discuss prostate exam screening with your doctor and decide what’s right for you. However, all men can improve their prostate health through diet and lifestyle changes, supplementation, and essential oil use.
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