Absent firm scientific grounding, it is not possible or desirable, in my opinion, to promote a uniform policy on screening. As I will discuss, our uncertainty about the value of prostate cancer screening means that physicians make screening decisions on an individual basis. The best policy is shared, informed decision making, in which a physician treats each patient as an individual, teaching him about prostate cancer and helping him to decide. Prostate cancer screening is not for everyone. Prostate cancer is, in many respects, a more complicated disease than breast cancer or colon cancer, for which we have generally agreed-upon screening policies.
Prostate cancer is largely a disease of older men, many of whom have other serious diseases.
Therefore, most men with prostate cancer die of something else. The side effects of prostate cancer treatment are more frequent, more long-lasting, and more serious than the treatment of cancer of the breast or colon. The components of screening are the screening test, a test to verify the diagnosis when the screening test is abnormal, and treatments for proven prostate cancer. Positive results are confirmed by a biopsy of the prostate. Patient with a positive biopsy may undergo staging tests, such as MRI and bone scan, to determine the extent of tumor spread.