The Latest Advice on Screening for Prostate Cancer

New Tests For Detecting Prostate Cancer

The concept of screening for prostate cancer is a moving target.  Screening for this common cancer in men has undergone significant changes in the past ten years.  This blog is intended to provide you with advice on whether you should participate in prostate cancer screening.

Another progress being made is that men with early-stage tumors have been spared the side effects of treatment, such as erectile dysfunction (impotence) and urinary incontinence, which can be devastating.  A recent report notes that 15 years after diagnosis, that 87% of men who underwent surgery and 94% of men who had radiotherapy were unable to engage in sexual intimacy.

So what do you need to know about prostate cancer screening?

Talk to your doctor about obtaining a PSA tests if you are at high risk for prostate cancer.  These include African American men who are twice as likely to be diagnosed with prostate cancer and have an aggressive form of the disease and 2.4 times more likely to die from it than Caucasian men.

Men with a family history of prostate cancer are twice as likely to have prostate cancer and to die from it.

New tests for prostate cancer

We have been looking for a test that will better predict prostate cancer than an elevated PSA level.  There are four new tests to enhance the diagnosis of prostate cancer.

A urine test, PCA3 looks for the presence of a specific prostate cancer gene.  This test is more accurate than the PSA test in deciding whether a man needs a prostate biopsy.

The Prostate Health Index (PHI) blood test evaluates three different components of PSA to determine whether the elevated PSA level is due to infection, benign prostate disease or possibly prostate cancer.

The 4K score blood test is similar to the PHI test but looks at four components which can predict a man’s risk of developing prostate cancer.

Finally, the prostate MRI or magnetic resonance imaging test which can accurately diagnose aggressive prostate cancer.

If any of these four tests are positive, then the next step is a prostate biopsy.

Bottom Line:

I suggest a baseline PSA test for all men at age 50 and for higher risk patients at age 45.  Men with very low PSA levels, less than 0.7ng\ml at baseline can have the PSA test every 5 years, and those 60 and older with levels less than 2.0ng\ml or lower may be able to avoid future PSA testing for the rest of their lives….as long as they remain symptom free.  If you have any questions, check with your doctor.

 

 

To Screen or Not to Screen For Prostate Cancer-That Is the Question.

Helping to answer the questions of screeing for prostate cancer

Prostate cancer is one of the most common cancers to affect men and is the second most common cause of cancer death in men following lung cancer.  There are over 30,000 deaths in the U.S. each year from prostate cancer.

Screening for prostate cancer has been controversial for the past few years.  A U.S. Task Force recommended against screening all men for prostate cancer.  This task force felt that there were too many false positive tests, too many prostate biopsies and too many men receiving treatment such as radiation therapy and surgery which result in complications such as erectile dysfunction\impotence and urinary incontinence.

Now that same Task Force released new recommendations that men aged 55-69 consider screening after a discussion with their doctor about the risks and benefits associated with screening and then the men and their doctors should decide on the best course of action regarding proceeding with a screening PSA test.

It is true that screening offers a small potential benefit of reducing the chance of dying of prostate cancer.

The same Task Force recommends against screening for men 75 years of age and older.  As many of these men will have slow-growing prostate cancer and will not likely succumb to the cancer but likely will die of some other cause.

My advice for men with a family history of prostate cancer, that is a man with close relative such as father, brother, or uncle with prostate cancer strongly consider having a PSA blood test as there is an increased likelihood of prostate cancer and an increased risk of dying from prostate cancer in men with relatives who have the disease.  The same advice also applies to African-American men who also have an increased risk of developing prostate cancer.

Bottom Line:  Not every man needs to be screened for prostate cancer.  However, every man should have a discussion with their doctor and review the benefits vs. the risks of screening and then make the screening decision.