The prostate is a gland about the size of a ping pong ball men have which sits between the bladder and the penis, and just in front of the rectum. The urethra runs right through the middle of it. The prostate’s job is to secrete some of the fluid which makes up semen.
Often men only become aware of their prostate when they are older, and typically because it becomes enlarged and causes symptoms, including urinary difficulty (frequency, hesitancy). Sometimes this growth is not a huge deal (benign prostatic hyperplasia, or BPH).
However, other times the cause of an enlarged prostate is cancer.
Prostate cancer screening guidelines have gone back and forth over the years, advising doctors to alternatively screen or not screen their patients based on risk factors and age. Typically, such screening is done with a PSA (prostate-specific antigen) test, a simple test of the patient’s blood. Alternatively, the doctor might screen with a digital rectal exam (DRE), feeling the prostate through the patient’s rectum for any bumps or hard areas.
Currently the American Cancer Society recommends screening only for certain men at certain ages with certain risk factors.
In part, this is because testing for prostate cancer has risks itself, including possible invasive procedures like biopsies that can result in unwanted complications such as urinary incontinence or impotence (here is a link to a handy graphic on the subject).
Prostate cancer screening is also necessary when patients have been previously diagnosed with and treated for prostate cancer. One such circumstance is when a patient has been treated with brachytherapy (implanting radioactive seeds directly into the prostate). In such a circumstance, screening for prostate cancer recurrence is necessary to confirm whether the cancer was successfully treated or not.
Prostate cancer screening failures occur when a doctor (often a primary care doctor or urologist) has a duty to screen her patient and fails to do so. The doctor could fail to ever order a PSA test, or the hospital or clinic could fail to have a simple system in place to automatically alert the doctor to order an annual PSA test. As a result, a patient’s cancer may be left untreated and allowed to grow. This can sometimes result in the cancer spreading outside of the prostate to other areas of the body.
