As an accidental prostate cancer survivor (diagnosed with Stage T2C prostate cancer when I had a negative DRE and a 3.2 PSA - both putting me in the "normal" range) believe that the issue is not early detection of prostate cancer, but treatment decisions made following diagnosis. Prostate cancer is almost a mirror image of breast cancer, and it kills almost 29,000 men each year. What is needed is a better method of determining which cancers are aggressive and which are not. in my view, convincing men, who already are reluctant to talk about this disease because of feared treatment consequences, that they do not need to test until later in life simply condemns more men to dying from the disease. We often hear something like this: "Don't worry about prostate cancer because chances are you will die from something else." If that is truly the case, why have over 1 million men perished from prostate cancer since the War on Cancer was declared in 1971? Although I am not a medical doctor, just a 6 year accidental prostate cancer survivor, i would suggest that every man begin PSA testing at age 35 and track any change in value year-over-year. This would allow us to detect aggressive cases early and perhaps generate a database that would allow for better treatment. I am riding across the US and back this summer to raise awareness about this issue. Please join me for a portion of the ride: http://www.tourdeusa.org. Robert Hess, President, Prostate Cancer Awareness Project, Accidental Prostate Cancer Survivor, Class of 2003.

Any discussion of prostate cancer is incomplete without mentioning a common side effect of surgical removal of the prostate; Peyronies Disease. This disease, for which there is no satisfactory treatment, results from formation of penile scar tissue, makes intercourse difficult or impossible and is often accompanied by excruciating pain. It was reported in the July 2008, edition of Medical News Today that almost 20% of men developed this condition after removal of the prostate.

When I developed this condition, I was unaware that a disease like this even existed. In frustration, I started an informational website, www.curepeyronies.net Every email I get describes a man in a desperate situation with nowhere to turn. Urologists must do a better job of informing patients of this rather common side effect, so they will be able to give informed consent before undergoing treatment.

First off, prostate cancer is a terrible disease and I commend urologists in their fight and plight against this scourge. That said, the PSA test is not a specific test, it is not a sensitive test. Screening tests are generally given to populations that are mainly without disease, so when there is an error it often falls in the majority group, ie the people without disease, i.e. a false positive result. If there is a positive finding the follow-up test, prostate biopsy is both expensive and poses a not insignificant risk to the patient. If the result was not a false positive their is then no good way to stratify which are the very slow growing prostate cancers which might be addressed with "watchful waiting" versus the more malignant and aggressive types. Finally if one chooses to intervene there is no home run treatment in fact its hard to say whether the treatments are often really of much benefit at all in terms of over all mortality while they carry a significant risk of long term complications. Evidently, two recent studies have now also supported that PSA screening is not of benefit and may actually be harming patients from the unnecessary procedures secondary to false positives.

So likely the PSA test isn't worth it, which then brings up a related question which may sound flippant but I think is entirely reasonable. Unless you have Dr. Goldfinger, the dreaded finger wave is a worse test than even PSA as a screening test. Is their any rationale reason for a digital rectal exam as a routine urologic screening?
http://healthjournalclub.blogspot.com/

I like very much what Mr. Hess said. Truly a contrarian and source of wisdom in the midst of all this "informed consent" banter regarding prostate cancer screening. Ps. when will you be riding through the Atlanta area?