CHARLOTTE, NC (WBTV) - Brothers Ralph and Robert Grier have many things in common.
"I'm two minutes older," says Ralph.
They are twins and they have a strong family history of cancer.
"The younger brother had the first diagnosis for prostate cancer, I was the second to be diagnosed in December of 2007 and Robert was about nine months later," added Ralph.
Because of the high risk of prostate cancer in their family Ralph and Robert have been getting screenings since the age of 40.
"The basic thing is we do the PSA testing, if that's abnormal, most of the time we do a prostate biopsy and see if they have cancer," said Dr. Daniel Watson a Urology and Oncology Specialist with Novant Health.
Dr. Watson says PSA screenings has its pros and cons and it's not recommend unless you know you are at risk.
Two thousand prostate cancers are diagnosed each year.
Most are slow growing and will never need treatment but a small percentage will become aggressive, the problem is experts can't agree on which way is best.
"It would be great to have a molecular test that says you have these 6 genes which means you're likely to have an aggressive form of the cancer," said Dr. Watson.
Low risk patients that have no genetic link have a little more guess work to do.
They have two options: undergo treatment that can come with serious consequences including incontinence or impotence, or patients can be monitored and run the risk of the cancer spreading.
A more precise test to check for the cancer is not common.
"The actual genetic testing is kind of expensive," says Dr. Watson.
"Some of the actual companies that had a lot of that testing available actually went bankrupt because insurance companies aren't' paying for it."
Since there are no clear answers on who should have screenings Dr. Watson takes a conservative approach.
"I have more people that are doing surveillance and not actually being aggressively treated."
Prostate cancer is considered to be a silent disease and there are no symptoms unless it's too late.
However with PSA screening doctors say the death rate from prostate cancer has declined from about 41 thousand men per year in the year 2000 to about 24 thousand men now per year.