For men, prostate cancer is the most common non-skin cancer and second leading cause of cancer death.
Over the past few years, prostate cancer screening has become a confusing topic for middle-aged men. Doctors have found an increasing number of patients with serious misinformation about prostate cancer screening and its implications. And, media coverage has prompted many men to forego most, if not all, testing for the disease.
Hopefully, this article will help clarify what prostate cancer screening involves and who should be tested.
How is prostate cancer screening done?
To begin, the prostate is a walnut-sized organ, deep in a man’s pelvis, resting on top of the rectum and attached to the bladder and urethra. Its simple function is to make semen, and, thus, it’s a non-essential organ. Because of its location, the prostate can be examined by a routine rectal exam in a physician’s office. A PSA blood test (prostate-specific antigen) may also be done as part of an exam.
If you’ve followed stories in the press, you know the PSA test is a useful, though not perfect, screening tool. Generally, the PSA test reading should be less than 4.0, but there are variations on how this result may be interpreted.
The difficulty with the PSA test relates to its lack of cancer specificity. While the reading may be elevated as a result of prostate cancer, it can also be abnormal because of other, non-cancerous reasons—such as prostate or urinary infection, benign prostate enlargement, or even recent ejaculation. It’s often difficult for a urologist to determine the basis for an elevated reading, and so additional testing—often including a prostate biopsy—may be recommended.
Most doctors agree that there’s been over- diagnosis and over-treatment of some clinically insignificant or non-life-threatening prostate cancers—small volumes of slow growing cancers, unlikely to shorten a man’s lifespan. However, it’s also noted that as a result of screening guidelines, prostate cancer deaths have declined in the U.S.
The National Comprehensive Cancer Network (NCCN) recently cited two important studies that looked at PSA screening over a 13-to-15-year period. The results showed not only significant reduction in mortality but also that only 98 patients need to be screened and five treated to save one life, paralleling breast cancer screening.
It’s also been shown that 30 to 50 percent of men detected with prostate cancer don’t require treatment, although a significant percentage harbor potentially aggressive disease. Because of this, an increasing number of patients elect active surveillance—continued close observation of their cancer—and understand that treatment could be recommended in the future.
What are screening guidelines?
To help clarify this issue, the American Urological Association (AUA) and National Comprehensive Cancer Network (NCCN) released guidelines citing the benefits of targeted PSA screening. All screening should be undertaken after thorough discussion with a physician.
The AUA recommends prostate cancer screening combining PSA blood test and prostate examination on a prescribed schedule. Men should not be screened until they are at least 40 years old, regardless of family history of prostate cancer or ethnicity. Men between 40-54 should be screened only if there’s a family history of prostate cancer or if they’re African-American. Between 55-69, screening is recommended every two years. Screening after 70 is currently not recommended. Again, these are general guidelines and a discussion with your physician is essential.
Is other testing recommended?
Research shows there are different genetic markers in prostate tissue and urine that can help clarify PSA results and prostate cancer diagnoses. The FDA has approved several available tests, and specialists are using these cutting-edge tests to ensure that patients get individualized evaluation and treatment.
Prostate cancer screening remains a controversial topic for men as they approach middle age. The most important advice is that men have clear discussions with their physicians and not ignore this critical topic. The future is likely to show exciting improvement in screening and treatment as new research on prostate cancer continues.
Thomas F. Lanchoney, MD, FACS, is a graduate of the University of Pennsylvania School of Medicine, where he did his internship and residency. A member of Urology Health Specialists, he specializes in da Vinci robotic and minimally invasive surgery. Find out more at UHSurology.com.