Just when you thought you had the whole screening for prostate cancer thing figured out, the American Cancer Society goes and changes the rules. It used to be, men were told to have a PSA test done annually after the age of 50 (or 40, if they’re African American or have a family history of prostate cancer). Now the experts are saying, you should talk to your doctor first about the good and bad points of screening before you do it, if you have it done at all (a link to the revised ACS guidelines is below).

Apparently, the problem is that it’s pretty hard to tell if regular screening by blood test and digital exam really saves lives. The latest studies show that statistically, screening can lower your risk – slightly – but can also detect cancer that’s non-aggressive and doesn’t need to be treated right away. I’ve been seeing many reports lately that claim prostate cancer is overtreated in this country and that some forms of treatment cause after effects that are actually more harmful to the patient in the long run than simple monitoring of the cancer (what’s called “watchful waiting”). In this case, the cure is worse than the disease.

I think part of the problem with over treatment comes from our leftover attitude about the word “cancer”. Those of my generation and older (I just turned 54) remember a time when a cancer diagnosis was practically a death sentence. You wrote your will, put your affairs in order and waited for the worst. That’s not the case anymore, of course, and we can all be thankful there are millions of cancer survivors today who will go on to live long and active lives. And prostate cancer is about the most treatable of them all, if it’s caught early. But the memory – and fear - of what the word cancer used to mean lives on in our minds, so that when you’re sitting across the desk from your urologist and he tells you you have prostate cancer, your immediate and automatic reaction is, “Let’s get rid of it. As soon as possible, by whatever means, get rid of it.”

Watchful waiting seems akin to saying, “Yeah, I know I have cancer, but I think I’ll just sit back and do nothing and see if it kills me.” It’s in the American DNA that when you're faced with a problem, you attack it, not wait to see if it gets worse.

I’ve experienced some of the side effects of treatment myself and have had my share of second thoughts about whether my choice of treatment (robotic surgery) was the right one. I can sympathize with the suggestion that prostate cancer is over treated and that screening is overdone. But it’s still a disease that kills nearly 30,000 men a year and is the second leading cause of cancer-related death in the United States among men.

I'm concerned about how the new Cancer Society guidelines are going to be received by the public. Many men are all too eager to place screening for prostate cancer under the category of Things I No Longer Have to Worry About. That’s not what the Cancer Society is saying with its new guidelines, but that’s what a lot of guys are going to hear.

For see the revised guidelines, visit Cancer.org. 

Read other blog entried by Joel Allen here.