It's easy to get confused amid the ongoing debate and conflicting recommendations about prostate cancer and screening. As the Chairman of the Prostate Conditions Education Council (PCEC) and as a researcher involved in hundreds of studies including two recent studies that have received international attention - the Prostate Lung Colorectal Ovarian (PLCO) and the SELECT trials - I'm often consulted by physicians and other healthcare providers about the intricacies of the data. But ultimately, there are millions of men who are each making a personal decision about prostate cancer screening and treatment and they need advice.

This is when I take step back from all of the policy and clinical debates and think about what I tell my three sons, all over 35 years old, as advice when it comes to prostate cancer.  

• Get a baseline PSA and Digital Rectal Exam at 35 years old and then based on the results on that PSA, develop a testing plan for the future.  The PSA provides valuable information to them but is in no way a diagnosis of the disease.  

• I reiterate to them that researchers are working diligently to develop new screening tools and markers for prostate cancer that we hope will better define the risk and aggressiveness of the disease. There are also promising new tools such as Staging Biopsies and new treatments like Targeted Focal Therapy which will help to enhance the decision making process and minimize the side effects of treatment should they ever need it.   Until science has caught up with the tremendous need in prostate cancer, we can only make the best use of the tools and information we have available to us.

• An early diagnosis of prostate cancer would offer them many more treatment options. They should never undergo a treatment for prostate cancer because of the inherent fear of the word cancer. Rather, they should take the time to gather as much information as possible about their disease and develop an appropriate treatment plan that they understand and are comfortable with.  

• Lastly, I share with them that the best prevention for prostate cancer that we have today is a healthy lifestyle. Exercising and healthy eating will help them reduce their risk for this disease and many others.

Dr. E. David Crawford is a world-renowned expert in prostate cancer. He is a practicing physician, researcher and father of three sons.

The Prostate Conditions Education Council (PCEC) opposes the draft recommendations prepared by the U. S. Preventive Service Task Force (USPSTF) on the use of the prostate-specific antigen (PSA) test for prostate cancer early detection.

The PCEC believes that the USPSTF recommendations will do more harm than good. The proposed guidelines will result in an increase in the mortality rate from prostate cancer, which will be most apparent in those at high risk, including African American men.

The PCEC endorses the use of PSA, in conjunction with a DRE, as the best tool widely available today for the early detection prostate cancer. When interpreted appropriately, the PSA test provides valuable information for risk assessment, diagnosis, monitoring and treatment decisions for prostate cancer patients and physicians.   

The PCEC also recognizes the importance of the development of new prostate cancer biomarkers that are more sensitive and specific and encourages the Food and Drug Administration (FDA) to recognize the time sensitive needs for review of the biomarkers currently submitted and those that will be submitted in the future.  

It is the belief of the PCEC that Knowledge is Power.  The screening and early detection of prostate cancer afford men a great number of treatment options for their disease, one of which is watchful waiting.  It is our belief that the men and their loved ones have not only the fundamental right to be informed of a disease while it is survivable but also have the capacity to make intelligent choices when presented with information on the positive and negative aspects of screening, diagnosis and treatment of prostate cancer. We agree with the USPSTF that many men are over-treated for prostate cancer and that we should separate diagnosis of the disease from treatment through informed decision making. 

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