Dr. Margot Savoy, chair and associate professor of Temple University's Department of Family and Community Medicine(Photo: Temple University Health System)

When men with concerns about prostate cancercome to see Dr. Margot Savoy, she knowstheir age, race andfamily medical history are important.

She also knowsthat once someone is screened, they can't unlearn the results.

In some cases, this isn't a problem. In others, it is.

Sometimesa patient with normal results chooses to ignore other symptoms. Other times, a patientwith abnormal results becomes overly aggressive in seeking treatment.

Those patients often get treatments to eliminate the cancerous cells before they become too powerful which puts them at risk for complications that could severely decrease theirquality of life.

Thesedecisions of when to screen and when to treat are part of a controversial balancing actchurningthrough the medical community.

"I ask them up front," said Savoy,an associate professor and the chair of Temple University's Family and Community Medicine Department. "If this number is a little bit off, but you have no symptoms and I think you have a low risk, are you going to be OK sitting on the number knowing that (the cancer) isthere or are you going to be worried that a ticking time bombis waiting to kill you?"

Simply put, what do patients do with their results when they come back?

Most screenings for prostate cancer include a PSA and DRE (digital rectal exam). The PSA measures the level of PSAs or prostate-specific antigens in the blood.

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A score above 20 is usually causefor concern and often leads to a biopsy.

Biopsies are conducted by using a needle to collect tissue samples;they require more preparation and can cause painful side effects, such as bleeding, incontinence and infection.

Based on the biopsy, the patient is usually assigned a Gleason score, which ranges from 2 to 10; the higher the score, the higher the risk of cancer.

Does screening reduce death rates from prostate cancer? No.

In 2012, several researchers measured the effects of prostate cancer screening on mortality by reviewing the results of aPLCO trial (Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial)and published their findings in the National Cancer Institute's journal.

The results were counterintuitive:

After a decade of watching 76,685 men ages 55 to 74, they foundno difference indeath rates between men who had an annual screening and men who were screened as part of their usual care.

Moreover, they found evidence that African American men in the trial who were given biopsies the next step if PSA results are abnormalwere "significantly more likely to have major infections."

The results made several health organizations change their screening recommendations.

Who should get screened and how often? It depends on whom you ask.

The American Association of Family Physiciansand theUnited States Preventive Task Force, a panel of health care experts, recommend against routine screenings for men ages 55 to 69, and instead suggest screenings on acase-by-case basis.For men over 70, both organizations recommend against any screenings.

The American Urological Association follows those recommendations and alsorecommendsagainst routine screening for men they define as low-risk white males ages 45 to 54 with no family history of prostate cancer.

But these recommendations are not definitive.

The three organizations note that African American malesages 45 to 54 and men with a family history of prostate cancer may benefit more from PSA screenings.

RELATED: Why are there racial disparities in cancer? Doctor gives clues in Milwaukee presentation

Moreover, astudy published in a urology journal examined the test results of 456 men the urological association would consider"low-risk" and found that 23% of them tested positive for prostate cancer with Gleason scores of 7 or higher.

Had association guidelines been followed, their cancers could have been missed.

Savoy said that's why it's important to treat every patient individually.

"With the recommendations they have now... itmeans you should have a conversation with your doctor," she said.

Once a cancer diagnosis has been made, patients face a choice: seek treatment and risk complications that could reduce their quality of life, or watch and wait.

RELATED: What treatment is best for you? Shared decision-making could help you choose -- if health systems made it a priority.

Much of the choice is dependent on the severity of the cancer; cancers with a Gleason score of 7 or higher are often recommended for treatment.

Common treatments for prostate cancer include surgery, radiation, chemotherapy, hormone treatments, biological therapiesand others.

There are also rarer treatments being tested in clinical trials, such as cryosurgery, which uses cold temperatures to freeze and kill the prostate's cancer cell; it is usually only used for recurrent cases.

What are the most common complications? There are several.

Part of what makes the decision difficult is that there is no way to tell who will experience harmful side effects and who will not.

The American Cancer Society details many of those side effects, such asfatigue, bowel problems, urinary incontinence, erectile dysfunction, loss of fertility and smaller reproductive organs.

In 1991, a study conducted by David M. Quinlan found that of 503 men who were potent pre-operatively, 32% were not a year and a half after operations for prostate cancer; he also found thatrecovery times were two to four years.

A study in 2014 found that one in five patients who received radiation or had their prostate removed returned to the hospital within two years with complications that werenotincontinence or impotence.

The risks give many pause.

Is there another option? Active surveillance.

Prostate cancer led the number of newly diagnosed types of cancer for men in 2016 at 192,443 (lung and bronchus cancers werethe second most diagnosed cancer for men at 113,044), according to the Centers for Disease Control and Prevention.

But prostate canceris far less deadly than lung and bronchus cancers, which are the leading cause of cancer death in men.Prostate cancer has a five-year survival rate of 97.5%, while the five-year survival rate for men with lung canceris only 16.2%.

Why the difference?

Many prostate cancers are indolent, meaning they grow at such slow rates, whoever has the cancer is likely to die of something else before they die from cancer.

"There have been men who had an autopsy done on them when prostate cancer was found, but they had died of something else; their cancer was never going to be the thing that killed them," Savoy explained.

That's why instead of treatment, some prefer to watch and wait.

Doctors call it active surveillance.

Patients come in for regularblood tests to monitor their PSA levels so any spikes or new symptoms can be detected quickly; "regular," according to Cancer.gov, means PSA tests every three months and biopsies every one to threeyears.

Can anything make the screening or treatment decision easier? Maybe.

Dr. George Vasmatzis, the director of the Center for Individualized Medicine Biomarker Discovery Program, discovered five genes that were more affected by prostate cancers with higher-risk than those with low risk.

The discovery may help men make the difficult decision on whether to get treatment or screened at all.

However, it remains in clinical trials.

Can youreduce your risk of developing prostate cancer? Yes.

The Mayo Clinic suggests men avoid high-fat foods, eat more fruits and vegetables, exercise several days a week and maintain a healthy weight.

Savoy agrees.

"When they think about what are the risk factors that could make a person have prostate cancer, a lot of them are things that you can't fix,like your age or your race,"she said.

"But you can easily change how many fruits and vegetables you can eat,so you are not entirely out of control because thats something everyone can do you have a recommendation even if you never get a test."

The American Cancer Society has a helpful guide on prostate cancer treatments.

Contact Talis Shelbourne at (414) 223-5261 or tshelbourn@jrn.com. Follow her on Twitter at @talisseerand Facebook at @talisseer.

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