Prostate cancer screening guidelines
Prostate cancer is the second most common cancer among men, and one in seven men will be diagnosed with it
during his lifetime. Screening, or early detection in men without symptoms, can identify men who are at risk for problems related to prostate cancer and may benefit from additional testing. ‘PSA’ (Prostate-Specific Antigen) remains the primary screening tool, which is a blood test that measures the level of a specific protein produced by cells of the prostate gland. But many considerations come into play on whether a man should have PSA screening at all.
Explains Dr. Elias Hyams, a urologist with ColumbiaDoctors, the faculty practice of Columbia University Irving Medical Center. “Urologists interpret PSA levels in the context of other risk factors such as age, ethnicity, family history, and the prostate exam. From there we determine the need for additional testing.”
While a high PSA level can be the first sign of prostate cancer, there are other, less threatening conditions that can produce elevated test results. “As men age and the prostate grows, the PSA typically rises, separate from risk of cancer,” says Dr. Hyams. “This can cause false alarms.” Other benign conditions that can affect PSA include urinary tract infections, procedures on the urinary tract, certain medications, and swelling of the prostate gland (prostatitis). “Fortunately, we have a growing repertoire of tools to clarify risk in men with elevated PSA – blood, urine, imaging, and other tests to determine who truly needs a biopsy, versus reassurance.”
A doctor/patient partnership
Last year, The United States Preventive Services Task Force (USPSTF) updated its recommendations for prostate cancer screening, saying that men should discuss PSA screening with patients in a “shared decision-making” approach, incorporating medical judgment and patient preferences.
The American Cancer Society (ACS) concurs, advising that men have the opportunity to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made only after examining the uncertainties, risks, and potential benefits of the screening particular to each patient.
Says Dr. Hyams, “While it’s true that there are downsides to screening, we are thoughtful in how we interpret screening results, and rely on validated follow-up tests before pursuing invasive testing. Furthermore, through improvements in biopsy techniques, specifically MRI-fusion biopsy, and observational management of ‘low risk’ prostate cancers, we reduce the likelihood of over-diagnosis and over-treatment of cancers that are slow growing and not likely to cause harm.”
When to start the conversation
According to the American Cancer Society, age recommendations for men to initiate a discussion with their doctor about PSA screening are as follows:
- Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
- Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).
- Men without symptoms of prostate cancer who do not have a 10-year life expectancy should not be offered testing since they are not likely to benefit.
If there is sufficient concern, a prostate biopsy can be performed in the doctor’s office. This is a 10-15 minute procedure done with local anesthesia. If a diagnosis of prostate cancer is made, follow-up discussions determine whether the cancer needs to be treated (slow growing cancers can often be safely monitored), and if so what type of treatment would be appropriate (often surgery or a form of radiation therapy).