Defense Secretary Lloyd Austin is urging others to get screened for prostate cancer. Why aren't they recommended for all men?

Secretary of Defense Lloyd Austin.
Secretary of Defense Lloyd Austin was diagnosed with prostate cancer in early December. (Alberto Pizzoli/AFP)
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Defense Secretary Lloyd Austin had his first press conference on Thursday since returning to work after treatment for prostate cancer. Before taking questions from reporters, Austin took the opportunity to encourage other men to get screened for the disease.

"I'm here with a clear message to other men, especially older men: Get screened. Get your regular checkups," he said. "Prostate cancer has a glass jaw. If your doctor can spot it, they can treat it and beat it."

This comes after Austin came under scrutiny for not disclosing two recent hospitalizations that turned out to be for prostate cancer treatment and subsequent complications. Austin was diagnosed with prostate cancer in early December and had a prostatectomy, which is the surgical removal of part or all of the prostate gland, on Dec. 22. More than a week later he was rushed to the intensive care unit at Walter Reed National Military Medical Center in Maryland, where he was readmitted due to “nausea with severe abdominal, hip and leg pain” and diagnosed with a urinary tract infection.

"The side effects I experienced are highly, highly unusual," Austin said on Thursday. "So you can count on me to set a better example on this issue today and for the rest of my life."

Apart from skin cancer, prostate cancer — which affects the part of the male reproductive system responsible for producing the fluid that nourishes and transports sperm — is the most common cancer in American men. Yet prostate cancer screening isn’t a routine part of preventative care the way tests for many other cancers are.

“Prostate cancer screening trials have been quite controversial,” Sandy Srinivas, a Stanford Health Care professor of urologic oncology, tells Yahoo Life. “Unlike mammography, Pap smears and colonoscopy, prostate cancer screening has not been associated with prolonging lives.”

So how do you know if or when prostate screening is a good idea? Here’s what the experts say.

What is a prostate exam?

There’s no standard test for prostate cancer, but common screening methods include:

  • Prostate specific antigen (PSA) test. This test measures the level of PSA (a substance made by the prostate) in the blood. A higher PSA level may indicate a problem with the prostate, but a number of factors can affect PSA level, including age, race, certain medications and an enlarged prostate.

  • Digital rectal examination (DRE). A health care provider inserts a gloved, lubricated finger into the rectum to feel for abnormalities such as cancer. The U.S. Preventive Services Task Force doesn’t recommend this, however, because there’s a lack of evidence on the benefits.

Why prostate cancer screening isn’t for everyone

Many prostate cancers grow slowly and don’t spread beyond the prostate gland. Many men also never experience symptoms and without screening wouldn’t know they have the disease. Because of this, prostate cancer screenings are not recommended for men age 70 and older, or men who have less than a 10-year life expectancy.

The U.S. Preventive Services Task Force also notes that there are “potential harms of screening” for prostate cancer that should be weighed along with possible benefits, including:

  • False positives. In addition to causing needless worry about one’s health, a false-positive test result can lead to unnecessary tests like a biopsy of the prostate, which can cause pain, blood in the semen or infection.

  • Overdiagnosis and overtreatment. The Centers for Disease Control and Prevention says that “overdiagnosis” means men who would not have had symptoms or died from prostate cancer can have complications from treatment, yet not receive any benefit from treatment. Common harms from prostate cancer treatment include urinary incontinence (experienced by about 1 in 5 men who have the prostate removed), erectile dysfunction (experienced by about 2 in 3 men who have the prostate removed and half of men who receive radiation therapy) and bowel problems (experienced by about 1 in 6 men who have radiation therapy).

  • Financial burden. Dr. Andrew Sun, a urologist and chief medical adviser for Marius Pharmaceuticals, tells Yahoo Life: “The screening and subsequent testing or treatment of prostate cancer often results in increased costs, medical risks and patient anxiety that’s simply not necessary with respect to the impact of that prostate cancer on that patient’s life span. ... And the unnecessary financial burden to the health care system is immense.”

Who should get screened for prostate cancer?

The U.S. Preventive Services Task Force is in the process of updating its recommendation on prostate cancer screening but currently says that men ages 55 to 69 years old may make the individual choice to undergo a periodic PSA-based screening, and that “screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men.”

“Having that discussion with your doctor and going through the risk/benefit is important if you are worried about the possibility of prostate cancer,” Srinivas advises.

Dr. Michael Whalen, vice chair of the department of urology and associate professor of urology at the GW Medical Faculty Associates, tells Yahoo Life: “All men over the age of 55 with life expectancy greater than 10 years should discuss prostate cancer screening with their primary care doctor. There are some men at higher risk, and they should begin prostate cancer screening at age 40.”

Factors that can put a man at higher risk include:

  • Family history. A family history of not only prostate cancer, but also breast, ovarian or pancreatic cancer may mean it’s a good idea to test earlier. “These other cancers may be associated with gene mutations that predispose to prostate cancer as well,” Whalen explains.

  • Race. “African American men have not only a higher incidence of prostate cancer, but also higher risk of death from prostate cancer,” he says.

“Although doctors always recommend a healthy diet, exercise and lifestyle for all patients, there are no specific foods that definitively lower the risk of prostate cancer,” Sun says. “The best thing patients can do is keep up with their routine checkups with their doctor, including prostate cancer screening — a simple PSA blood test — when the time comes.”

This article was originally published on Jan. 10, 2024 and has been updated.