I want to change pace a little today and instead of directly discussing advanced prostate cancer, I am going to discuss an issue that has been coming up in our community, universal prostate cancer screening.

We have all been embattled in an on going dispute, a disagreement about the value of general prostate cancer screening. Some people argue against the need for prostate cancer screening as it causes men who are not in need of treatment to go out and get treatment (over treatment).

We all acknowledge that current treatment modalities often cause significant compromises in the quality of life (QOL) after treatment for both the survivor and his family. Therefore, the over treatment causes many men and their families to suffer the deleterious and unnecessary diminution of their quality of life.

We also hear that “men die with prostate cancer, not of prostate cancer.” True, many men do die of causes other than prostate cancer, even if they have prostate cancer. We also hear that at autopsy many older men will have some prostate cancer in their prostate gland.

Both of these statements are correct, but neither provides a reasonable rationale for not standardizing regular prostate cancer screening (PSA and DRE followed by a biopsy if needed) program for all men over 45 years.

The issue of the QOL effects caused by over treatment is the most commonly cited reason to end general prostate cancer screening. The logic is that without detection there would not be the over treatment we currently experience. Here lies the flaw in the logic, the issue of over treatment which should not be confused with the screening.

The true problem is that men are not properly guided after diagnosis. Many men are not offered and so do not consider all their treatment options. Knowing that you have prostate cancer should not automatically mean that you should undergo invasive prostate cancer treatment. T