Prostate Surgery: The Good, The Bad, and The Ugly

The following is an excerpt from the Fall 2013 release of Ending Male Pelvic Pain, A Man’s Manual. This great book is a must have self-help resource for all men suffering from pelvic floor conditions. This blog post will will focus on some of the issues relating to prostate screening.


Approximately one in six men in the United States will be diagnosed with prostate cancer in his lifetime. Although the diagnosis of prostate cancer is common, recent research suggests that in many cases, the cancer will not spread, cause symptoms, or shorten a man’s lifespan if left untreated. This type of cancer is referred to as indolent cancer. Cases of indolent prostate cancer may be managed with an approach called active surveillance, which involves routine monitoring of the prostate by a physician to detect any signs of cancer progression.

Despite evidence that many cases of prostate cancer may be best managed with active surveillance, a majority of men diagnosed with early-stage prostate cancer choose immediate treatment with surgery, radiation or hormone therapy. Treating an indolent prostate cancer with the above methods can cause serious side effects such as urinary incontinence and sexual dysfunction. In other words, the treatments likely do more harm than good.

Diagnosis – PSA Screening

There has been much controversy over both the screening methods for detecting prostate cancer and the possible over-treatment of indolent prostate cancers. The prostate-specific antigen (PSA) test is a blood test that measures the amount of a specific protein produced by the prostate. Elevated PSA levels may be indicative of prostate cancer or a benign condition of the prostate, such as benign prostatic hyperplasia.

In May 2012, the U.S Preventive Services Task Force (USPSTF) issued a recommendation against PSA-based screening for prostate cancer. The task force concluded that more men are harmed by PSA screening than benefit. A summary of the U.S Preventive Task Force findings can be found in the following table.

Table 4.1: PSA Testing Benefits and Harms Potential Benefit from PSA Screening:

• 1 man in 1,000 (at most) avoids death from prostate cancer due to PSA screening. Potential Harms from PSA Screening:
• For every 1,000 men screened with PSA test:
– 30 to 40 will develop urinary incontinence or erectile dysfunction due to treatment.
– 2 men will develop a serious cardiovascular event, such as heart attack, due to treatment.
– 1 man will develop a serious blood clot in his leg or lungs due to treatment.
• For every 3,000 men screened with PSA test:
– 1 man will die due to complications from surgical treatment.

Many physicians and medical institutions disagree with the USPSTF recommendations and believe that PSA screenings should be performed, albeit more selectively, depending on known risk factors for developing prostate cancer. Risk factors for developing prostate cancer include:

• Age – Age is the greatest risk factor. Prostate cancer typically occurs in men over the age of 50.
• Race – African-American men are at higher risk of developing prostate cancer at a young age than are Caucasian men.
• Family history – Men with close relatives who have had prostate cancer are at a slightly higher risk for developing the disease.



Table 4.2: Prostate Screening Recommendations from Memorial Sloan-Kettering Cancer Center

• Men aged 40 should have a baseline PSA test IF they have one of the following risk factors:
– They have a family history of the disease.
– They are African American.

• Men aged 45 – 49 should have a baseline PSA test:
– PSA ≥ 3 ng / mL: men should talk with their doctor about having a biopsy.
– PSA = 1 – 3 ng / mL: men should repeat PSA test every 2 – 4 years.

• Men aged 50 – 59 should have their PSA level checked:
– PSA ≥ 3 ng / mL: men should talk with their doctor about having a biopsy.
– PSA = 1 – 3 ng / mL: men should repeat PSA test every 2 – 4 years.

• Men aged 60 – 70 should have their PSA level checked:
– PSA ≥ 3 ng / mL: men should talk with their doctor about having a biopsy.
– PSA = 1 – 3 ng / mL: men should repeat PSA test every 2 – 4 years.

• Men aged 71 – 75 should talk with their doctor about whether to have a PSA test:
– The decision whether to have a PSA test should be based on past PSA levels and health of the man.

• Men aged 76 or older:
– Prostate cancer screening is not recommended.


A high PSA level does not generally mean that a man should have a prostate biopsy. A doctor will often repeat the PSA test after a few months to determine if it is still high and investigate whether there is a reason other than cancer that could explain why the PSA level is elevated.

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