Archive for the ‘PSA guidelines’ Category

The New Skinny On Prostate Cancer Screening With the PSA Test

April 11, 2017

Prostate cancer remains one of the most common cancers in men and is the second most common cause of death from cancer in men.  (Lung cancer is still leading the list)  The American Cancer Society projects more than 161,000 new cases this year in the U.S., with about 26,730 deaths each year.  Prostate cancer accounted for 4.4% of all cancer deaths in the United States last year.

The U.S. Preventive Services Task Force, an independent and influential panel of experts, published new guidelines in early April 2017 for screening for prostate cancer for the first time in five years.

The new recommendations: Men ages 55 to 69 should “make an individualized decision about prostate cancer screening with their clinician.” That’s updated from a blanket recommendation in 2012 for no routine screening at any age.

The task force also recommends that those men older than 70 shouldn’t undergo PSA screening.

Now doctors are saying that the older recommendation in 2012, i.e., not to screen for prostate cancer likely resulted in deaths that could have been avoided..

The PSA test is a simple blood test that determines levels of the prostate-specific antigen protein, and elevated PSA can be a sign of prostate cancer. But elevated PSA can also be caused by other conditions, like inflammation of the prostate or benign enlargement of the prostate gland.

The risk of potential harm of over-diagnosis has led to confusing recommendations for screening. Treatment for prostate cancer, including removal of the prostate and radiation, is associated with the side effects of incontinence and erectile dysfunction.

False positives can lead to unnecessary further testing or treatment, and many cases of prostate cancer are slow-moving and require watchful waiting rather than immediate treatment.  This means that the men with slow growing, non-aggressive cancer can be followed with a digital rectal exam, frequent PSA testing, and perhaps additional prostate biopsies.

So how useful is PSA screening? According to the New England Journal of Medicine, studies imply that 1 prostate cancer death is averted per 1,000 men screened several times each, and followed for 10 to 15 years.

On the flip side, the authors reported, data show about 35 over-diagnosed cases per 1,000 men screened.

Some groups are at higher risk for prostate cancer, including African-American men and those with a family history of the disease.

Bottom Line: It is my recommendation to my patients 55-69 they have a discussion with their physician and weigh the benefits vs. the harms of PSA testing.  With that discussion the men can make the best choice for themselves, together with their doctor.

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The Skinny On Screening for Prostate Cancer

December 29, 2016

Prostate cancer is the second most common cancer among men (after skin cancer), according to the American Cancer Society. It is the second most common cause of death in following lung cancer and causes nearly 30,000 deaths annually in the United States.  The good news is that often prostate cancer can be treated successfully, especially when caught in its early stages.   More than 2 million men in America count themselves as prostate cancer survivors, according to the American Cancer Society.

At the present time screening for prostate cancer is controversial in the medical profession.  There are physicians who believe that testing all men for prostate cancer outweighs the benefit because it may find some very slow growing cancers in some men that could be left alone without any negative consequences. My personal opinion is that prostate cancer screening should be done but requires education and a decision made between doctor and patient.

My belief is that if prostate cancer is detected early, it has a favorable  prognosis. If men ask me what are the early signs of prostate cancer, the answer is that there are NO early signs of prostate cancer when it is confined to the prostate gland.  That is why men need to have an examination or the digital rectal examination and a PSA test.

Risk factors help determine who should be screened when

The protocol starts by evaluating men for their risk factors for developing prostate cancer. Risk factors include: age (after age 50 risk of prostate cancer rises rapidly); race (men of African-American and Caribbean descent are at higher risk); and family history (men who have a father, brother, or uncle with prostate cancer are at a higher risk of developing prostate cancer and should be screened on a regular basis) Men should be screened every year until they reach age 70 or 75. For most men who reach age 70 and all their screening tests are normal, the chances of their developing a cancer that would impact their well-being or their longevity is really low.

Managing the elevated PSA test

If your screening detects a possible cancer, your doctor will order a biopsy. This is done in the office under a local anesthesia and takes 10-15 minutes.  If the biopsy detects prostate cancer, then the next step is to determine the aggressiveness of the cancer or how likely it is to spread or grow.  For men with low-risk tumors that are not going to put their health or longevity at risk, I will often recommend surveillance, which means regular testing of the PSA and a follow up biopsy in 12-18 months.  As long as the PSA remains stable and there is no evidence of escalation of the cancer, then these men can be safely followed and only treated if the cancer appears to be growing or the PSA is steadily increasing.  Men with more aggressive tumors may need surgery and\or radiation. You and your doctor will make the best treatment decisions for you together.

Bottom Line:  Prostate cancer is a common cancer and can easily be diagnosed with prostate cancer screening.  Not all men need to be screened, but if you are between 50 and 70 years of age, speak to your doctor about the benefits of screening and make an informed decision if screening is right for you.

PSA Testing for Prostate Cancer-To Screen or Not to Screen That is the Question

September 28, 2016

Today, nothing is more confusing for men than the concept of screening for prostate cancer.  Prostate cancer is the second most common cancer in men, following lung cancer, and there are 250,000 men each year diagnosed with prostate cancer and causes nearly 30,000 deaths a year.  About one in seven men will be diagnosed with prostate cancer during his lifetime.

But some prostate cancers develop slowly, and, as the disease is more common in elderly men, most men with prostate cancer die with it and not from it. Thus, screening, diagnosis and treatment of the disease are controversial.

There is no consensus about prostate cancer screening as early diagnosis can be associated with very bothersome side effects such as erectile dysfunction and urinary incontinence.  Also screening has not been universally shown to increase survival or decrease the death rate from prostate cancer.  This article will discuss the pros and cons of PSA screening for men.

Men who opt for screening undergo a digital rectal exam and a blood draw to measure a chemical called PSA or prostate specific antigen. This level of PSA can be increased in men with prostate cancer. Other conditions may cause the increase in the PSA such as benign enlargement of the prostate gland and prostate infections.

The best way to detect an early potentially deadly case is to collect yearly PSA tests over three to five years so trends can be assessed.

I like most other urologists are concerned about over treatment of prostate cancer — in other words, being too aggressive in using surgery or radiation when a small amount of potentially slow-growing cancer is found on a biopsy.

The federal government has also become concerned about this issue. A large medical research trial called the Prostate Lung Colorectal and Ovarian (PLCO) Cancer Screening Study released results from 2009 showing no benefit from screening for prostate cancer when comparing a large group of unscreened men to a large group of aggressively screened men.

Researchers across the country are assessing the effects of the USPSTF recommendations on prostate cancer mortality since 2012. In a recent study from Northwestern University in Chicago, researchers found a significant increase in the cases of advanced prostate cancer already spread to other parts of the body from 2004 to 2013. As a result we could be missing serious cancers because of decreased screening.

Prostate cancer also has a hereditary predilection and men with a father, brother, cousin, or uncle should consider having screening around age 40.  This also applies to African-American men who have a greater risk of prostate cancer than Caucasian men and should also have testing after age 40.

My best advice is to ask your doctor\urologist about the decision to undergo prostate cancer screening.

PSA Testing-What Every Man Needs to Know

January 18, 2016

Prostate specific antigen is a simple blood test that can be a metric for prostate health.  It is a good screening test for prostate cancer.  This blog will discuss the PSA test and what you need to know to make a decision to obtain this common test.

Let’s start by reassuring men that having an elevated PSA level does not necessarily mean you have prostate cancer.

PSA is also likely to be increased with benign enlargement of the prostate gland as well as prostate infections or prostatitis.

It is important to emphasize that the PSA test is not a specific prostate cancer test, but it is a vital first step in screening for the potential presence of cancer.

The other factors that can cause PSA levels to rise:

  • Age: PSA levels can increase gradually as you age
  • Prostatitis: Inflammation of the prostate gland, due to infection or some unknown cause
  • Benign prostatic hyperplasia (BPH): This condition refers to an enlarged prostate.  More prostate means more cells making prostate specific antigen, increasing the potential for an elevated PSA.
  • Urinary tract infection: can irritate and inflame prostate cells and cause PSA to go up
  • Medications: Some medications like Proscar, Avodart, or Propecia can falsely lower your PSA.  This too is important to remember.  If you are on any of these medications, talk to your doctor.  The general rule of thumb is to double your PSA for an accurate score.
  • Sex/ejaculation:  This can cause a mild elevation in the PSA, but should return to normal after a few days. That is why I usually recommend that men refrain from sexual intimacy for 48 hours prior to PSA testing
  • Prostate trauma: Anything that causes direct trauma to the prostate such as riding a bike, having a catheter inserted into the blader, a prostate biopsy, or a cystoscopy which is a look using a lighted tube through the urethra (tube in the penis that transports semen and urine) can increase the PSA temporarily.

A PSA level of less than 4.0 ng/mL is normal, while changes of more than 2.0 ng/mL over the course of a year could be an indicator of the presence of prostate cancer.

I point out that there is a familial or inherited basis of prostate cancer and also an increased risk of prostate cancer in African-American men.  In these men who are are at a greater risk of prostate cancer, I suggest annual testing with a digital rectal examination and a PSA test after age 40.  For all others, I suggest testing begin at age 50.

For men who have an elevated PSA test, then a discussion with the doctor about repeating the test in a few weeks or proceeding to an ultrasound examination and a prostate biopsy is in order.

Bottom Line: PSA testing is a non-specific test used to screen for prostate cancer.  Not all elevations of the PSA test indicate cancer.  Further testing and close monitoring as well as a prostate biopsy is in order.  For more information, speak to your doctor.

Preventive Health For All Men

January 18, 2016

Do you know that most men spend more time taking care of their cars or planning a vacation than they do taking care of their health?  In the U.S., women live 5-7 years longer than men.  I believe one of the reasons is that women seek out regular medical care throughout their entire lives.  They see a obstetrician during child bearing years; they get regular mammograms; they obtain routine PAP smears and other preventive health measures for their entire lives.  Men, on the other hand, stop seeing a doctor around age 18 and never see the inside of a medical office until middle age.  During that time they can have high blood pressure, elevated cholesterol levels, diabetes, and prostate diseases.

But there are some things men, in particular, should keep in mind when it comes to maintaining their health:

Heart disease and cholesterol

According to the Centers for Disease Control and Prevention, about 200,000 people die each year from preventable heart disease and strokes, with men being significantly more at risk than women.

Men should begin screenings for these issues in their mid-30s.

Annual health examinations should begin at around age 50.  This should include a test for anemia, a cholesterol level, a chest x-ray if the man is a smoker, a PSA test for prostate cancer, and a blood pressure determination.

For those men with an elevated cholesterol level, they can lower the level by adhereing to  a healthy diet consisting less heavy in red meats and carbohydrates, and limiting alcohol consumption, i.e., 2 drinks\day. Men of all ages should also continue to stay physically active by incorporating aerobic activities, i.e., any activity that increases the heart rate for 20 minutes 3-4 times a week, into their lifestyle, as well as strength training.

Prostate health

There is some debate among health care professionals about when men should begin screening for prostate cancer. The U.S. Preventive Services Task Force and the CDC recommend against screening unless men begin experiencing the symptoms associated with prostate cancer. These include frequent urination, especially at night, pain during urination and difficulty fully emptying the bladder.

Prostate screening can begin earlier in life, around age 40, if there is a high risk for prostate cancer, such as family history, or bothersome lower urinary tract symptoms.

Testosterone

As men age, lowering testosterone levels can become another area men should monitor.  Significantly low testosterone levels can predispose a man to low bone mineral density with subsequent bone fractures, erectile dysfunction (impotence) and low energy levels.

Testing for testosterone levels is done through a blood test.

Bottom Line: these are the minimal preventive care that all men should consider around age 30-40.  Remember if it ain’t broke don’t fix it, may apply to your car, but not to your body.  You need to take preventive measures with your body just as you do with your automobile.

PSA Testing For Prostate Cancer-New Recommendations For 2015

February 16, 2015

In 2012 the United States Task Force released guidelines for PSA testing for prostate cancer that stated that no man should be tested for prostate cancer with a PSA test since there was far too many man who were over-diagnosed and who had treatment and complications from the treatment and that the cancer was so slow growing that few men would die of their prostate cancers.

Two physicians’ groups are now recommending informed decision-making when it comes to screening for prostate cancer. This is in line with American Cancer Society guidelines for early detection of prostate cancer.

The American Urological Association (AUA), the leading organization representing urologists, is recommending more moderate use of prostate cancer screening tests.

In its new guidelines, the AUA recommends that men ages 55 to 69 discuss the benefits and harms of prostate cancer screening with their doctors before deciding whether to be screened. It recommends against screening for men younger than 55 who are at average risk, as well as for men 70 and older.

The American College of Physicians (ACP) released a similar guidance statement in April 2013. The ACP says men between the ages of 50 and 69 should discuss the limited benefits and substantial harms of the prostate-specific antigen (PSA) test with their doctor before undergoing screening for prostate cancer. The guideline says only men between the ages of 50 and 69 who express a clear preference for screening should have the PSA test.

These new recommendations are closer to those of the American Cancer Society and several other groups issued in recent years. The American Cancer Society recommends that men discuss the possible risks and benefits of prostate cancer screening with their doctor before deciding whether to be screened. The discussion about screening should take place starting at age 50 for men who are at average risk of prostate cancer and expect to live at least 10 more years. It should take place at age 40-45 for men who are at higher risk, this includes African-American men and men who have a father or brother diagnosed with prostate cancer.

The discussion with the doctor should include an explanation to men of the uncertainty of the PSA test, potential harms from the prostate biopsy and treatments such as surgery and radiation, and potential benefits of PSA screening. Use of this test should be a decision made by the individual patient in collaboration with his healthcare provider.

Some limitations of screening

Screening looks for disease in people who have no symptoms. The main goal of prostate cancer screening is to reduce deaths due to prostate cancer. But the studies showed that the number of men who avoided dying of prostate cancer because of screening after 10 to 14 years was very small.

And screening isn’t perfect. Sometimes screening misses cancer, and sometimes it finds something suspicious that turns out to be harmless. The PSA test often produces false-positive results. For example men with an enlarged prostate gland or men with an infection of the prostate gland can have an elevated PSA level. Also, there aren’t reliable tests yet to tell the difference between prostate cancer that’s going to grow so slowly it will never cause a man any problems, and dangerous or aggressive prostate cancer that will grow quickly. Treatments for prostate cancer can have urinary, bowel, and sexual side effects that may seriously affect a man’s quality of life.

Bottom Line: The PSA is not a perfect test. It is inexpensive and it is non-invasive. It is useful as a baseline test and can help a man decide if he should proceed to a biopsy or to have treatment for his cancer. A thorough discussion between the man and his doctor is the best recommendation that I can provide for all men who are concerned about prostate cancer.

Elevated PSA Linked to Shiftwork

February 16, 2015

Men who work night shifts or rotating shifts are more likely to have elevated PSA levels than men who do not.
In an analysis of data from the National Health and Nutrition Examination Survey (2005-2010), Erin E. Flynn-Evans, PhD, of Brigham and Women’s Hospital in Boston, and colleagues found shiftworkers had a 2.6 times increased risk of an elevated PSA (4.0 ng/mL or higher) compared with non-shiftworkers after adjusting for confounders.
The researchers, who published their findings online ahead of print in the Journal of the National Cancer Institute, concluded that sleep or circadian disruption is associated with elevated PSA, indicating that shiftworking men likely have an increased risk of developing prostate cancer.
A previous prospective cohort study of Japanese rotating-shift workers demonstrated that, compared with day workers, rotating-shift workers had a significant threefold increased risk of prostate cancer after adjusting for age, family history of prostate cancer, and other potential confounders, according to a report in the American Journal of Epidemiology (2006;164;549-555).

Take Home Message: If you are caring for a middle age man who does shift work, it is a good idea to encourage him to get a PSA and a digital rectal exam annually.

More FAQs From My Patients

February 16, 2015

I have a high cholesterol level. Is there anything I can do to lower the cholesterol level besides medications, i.e., statins?
Yes, there are cholesterol lowering foods that are effective and have absolutely no side effects. These include:
Soluble fiber of 25gms each day is helpful and good for the colon as well. Good sources of soluble fiber include legumes such as peas and beans; cereal grains such as oats and barley and vegetables and fruits such as carrots, apples, and dried plums (prunes).
Nuts to the rescue. Although nuts are high in fat, the fats are predominantly monounsaturated and polyunsaturated, which are known to decrease LDL cholesterol levels or bad cholesterol. By eating a daily helping of nuts — about 2.4 ounces — results in an average 5% reduction in total cholesterol concentration. Nuts that will help lower LDL cholesterol levels include almonds, walnuts, peanuts, pecans, macadamias and pistachios.
Plant sterols and stanols, plant compounds that are structurally similar to cholesterol, partially block the absorption of cholesterol from the small intestine. They lower levels of LDL cholesterol without adversely affecting high-density lipoprotein (HDL or “good”) cholesterol levels. Plant sterols and stanols, plant compounds that are structurally similar to cholesterol, partially block the absorption of cholesterol from the small intestine. They lower levels of LDL cholesterol without adversely affecting high-density lipoprotein (HDL or “good”) cholesterol levels.
So you can begin by decreasing your consumption of red meat, butter, and high cholesterol containing seafood such as crayfish (heaven forbid!) shrimp and lobster and try these other non-medical options. If these do not work, then talk to your doctor about medication.

I am thinking of having a vasectomy. Is there any risk of erectile dysfunction or impotence?
No, you have nothing to worry about. A vasectomy ONLY prevents the sperm from entering into the ejaculate or seminal fluid. It does not affect the testosterone level or the ability to engage in sexual intimacy. If your erections are good before the vasectomy, they will remain just like they were prior to the vasectomy. So it is safe to proceed with the “prime cut”!

I am a man 78 years of age. Do I need to have a PSA test for prostate cancer?
No, the American Cancer Society and the American Urological Association do not recommend screening for prostate cancer with the PSA test in men more than 75 years. Cancer screening tests — including the prostate-specific antigen (PSA) test to look for signs of prostate cancer — can be a good idea in younger men between 50-75 but not in men over age 75. A normal PSA test, combined with a digital rectal exam, can help reassure you that it’s unlikely you have prostate cancer. But getting a PSA test for prostate cancer is not be necessary for men 75 and older.

I am 40 years of age and ate some red beets. My urine turned red. Is that normal after consuming red beets?
Usually red urine after red beet consumption is a result of a pigment, betalain, in the red beets and is nothing to worry about. However, if the red persists more than 24 hours after consuming the beets, then it is important to see your physician and have a urine examination. When the red color persists, this is referred to as hematuria. Hematuria is a clinical term referring to the presence of blood, specifically red blood cells, in the urine. Whether this blood is visible only under a microscope or present in quantities sufficient to be seen with the naked eye, hematuria is a sign that something is causing abnormal bleeding in the patient’s genitourinary tract. For more information on hematuria, please go to my website: http://neilbaum.com/articles/hematuria-blood-in-the-urine

Prostate Cancer –Management of Low Risk Disease*

July 27, 2014

Prostate cancer remains one of the most common cancers in men with 250,000 new cases each year and causes nearly 40,000 deaths each year. Like most other cancers there are shades of gray and not all cancers need to have treatment. This blog will discuss the use of androgen deprivation therapy and when it might used in men with advanced prostate cancer.

There’s nothing like an elevated prostate specific antigen (PSA) test result to strike fear into even the most unflappable and courageous of men. That’s because elevations in PSA in the blood can point to the presence of prostate cancer. On the other hand, elevated PSA can also indicate prostatic enlargement or inflammation of the prostate. However, an elevated PSA test result, combined with a digital rectal exam and a 12-core prostate biopsy to remove small pieces of prostate tissue from the gland, will provide a very good idea as to whether a man has cancer or not.

About 40 to 50 percent of the 241,000 men expected to be diagnosed with prostate cancer this year will have a suspicious PSA score and a Gleason score of 6 out of 10, which is based on the prostate biopsy. A Gleason score of 6 is an indicator of a very favorable or low-risk disease, a disease that is treatable and curable — if, in fact, a man chooses to treat it.

Facing treatment decisions. Once a man has a prostate cancer diagnosis, he then has to choose what type of treatment he wants, which can include surgery or radiation therapy; men with low-risk cancer can also opt for active surveillance, or close monitoring without any immediate treatment. However, these men have to have a digital rectal exam and PSA test and possibly a repeat biopsy on a regular basis.

The good news is that low-risk prostate cancer — meaning low grade and low stage with a PSA below 10 ng/mL — grows slowly, if at all. Therefore, a man should be sure to discuss with his doctor whether he really needs to undergo any therapy to treat his cancer. That’s because in the majority of cases the answer will be “not now.”

What we have learned over the years with low-grade cancer is that sometimes the best option is no treatment whatsoever. And that includes treatment with androgen deprivation therapy, or ADT.
Earlier this summer, I came across a study in JAMA Internal Medicine that reminded me that many men with low-risk prostate cancer are still being offered primary ADT to treat their cancer, something that we would not recommend at Johns Hopkins. The reason: ADT offers no survival benefit for men with low-risk cancer and it causes significant side effects, including osteoporosis, diabetes and decreased libido.

Androgen deprivation therapy (ADT)–also called hormone deprivation, or hormonal or androgen ablation–is effective at turning off the body’s supply of male hormones, which prostate cells need to grow and develop. When the supply is shut off by drugs or by removing the testes, a portion of the cancer dies, tumors generally shrink, and PSA levels drop.

It’s androgens, or male hormones, that stimulate the growth of prostate tumors. The two most common androgens are testosterone and dihydrotestosterone (DHT). Since the Nobel Prize-winning discovery by Dr. Charles Huggins of the University of Chicago that prostate tumors depend on these hormones to grow, reducing androgen levels or blocking the action of androgen (androgen suppression) has become the standard of care for men with cancer that has spread beyond the prostate (metastasized) to the bones and other organs. There has also been increasing interest in using it in men whose PSA level has begun to rise after treatment with surgery or radiation (“biochemical recurrence,” an early sign that the cancer has not been eradicated).

Most urologists typically wait until there is evidence of metastatic disease before starting with ADT. There is an exception, however, and that is when we see a rapid PSA doubling time (less than six months) — because this provides indirect evidence of micrometastic disease that will develop in the next few years.

While ADT plays a significant role in the treatment of advanced prostate cancer, it has no role in the treatment of older men with low-risk cancer. Yet primary ADT is nevertheless being prescribed for one in eight men over age 65 diagnosed with localized prostate cancer.

The JAMA article. In the JAMA Internal Medicine study conducted by Grace L. Lu-Yao, Ph.D., a cancer epidemiologist at the Rutgers Cancer Institute of New Jersey and professor of medicine at Rutgers Robert Wood Johnson Medical School, more than 66,000 older men with low-risk prostate cancer were followed for up to 15 years. Dr. Lu-Yao reported that those men who received ADT lived no longer on average when compared with men who did not receive the therapy.

Prescribing ADT for these low-risk patients may decrease the high anxiety level that a patient may have due to his cancer diagnosis, however, it is necessary to note that such treatment may carry more risk than benefit. ADT helps reduce anxiety by quickly dropping PSA levels into the undetectable range, so the doctors may feel that they are doing something positive for their patients. However, ADT may not really be in the patient’s best interest due to complex side effects. The doctor should really be talking to patients with low-risk disease about pursuing active surveillance, not ADT.

There are serious potential risks associated with ADT, including coronary heart disease, and the associated high costs of the medications, the use of primary ADT should be limited to patients in the high-risk cancer group who are not suitable for, or opt not to receive, primary therapy — surgery or radiation — that has the potential to cure.
The side effects associated with ADT. In general, hormonal therapy will cause significant side effects after several months of treatment. Long-term side effects of ADT may include one, some or all of the following:
• Anemia
• Coronary heart disease
• Decreased energy
• Decrease in mental acuity
• Depression
• Diabetes
• Erectile dysfunction
• Hot flashes
• Loss of muscle mass
• Osteopenia
• Osteoporosis

Bottom Line: Many men with prostate cancer who have low risk disease or who have recurrence after treatment with radiation or surgery. This is usually detected by a rising PSA after treatment for prostate cancer that is confined to the prostate gland. These men should have a discussion with their urologists and discuss if androgen deprivation therapy is really in their best interests and that the benefits vs. the side effects are worth the treatment with androgen deprivation therapy.

*This blog was modified from the Johns Hopkins Newsletter, July 2014

Prostate Cancer-Watch, Wait, and Not Whither

January 24, 2014

Prostate cancer is the most common cancer in men and the second most common cause of death in men after lung cancer.  The diagnosis is made with a PSA blood test and a digital rectal exam and if either of these are abnormal, the man is subjected to a prostate biopsy.  Then comes the big decision: does the man proceed to treatment and face the risk of urinary incontinence and\or erectile dysfunction\impotence?

In the past few years there has been a trend towards active surveillance or after receiving the diagnosis of prostate cancer, the man accepts close monitoring with repeated blood tests and possibly repeat prostate biopsies to make certain that the cancer is not progressing or escaping from the prostate and spreading to other organs or structures. 

First a comment on screening.  Men between the ages of 55 and 69 are those most likely to benefit from screening with a PSA blood test and a digital rectal examination.  A man should only be screened after a discussion with his\her physician about the benefits and harms of screening.  A new trend is not to treat every man diagnosed with prostate cancer or active surveillance.   Not every man qualifies for active surveillance. 

Men with a very low risk of cancer progression have a low-grade cancer of the prostate.  Prostate cancers are graded from 1-10 and those with a score of 6 or less may be candidates for active surveillance.  Men are in the very low risk group if only a few of the biopsies are positive for cancer and that the cancer is not felt on the digital rectal exam. 

Men who were on the active surveillance program at John Hopkins School of Medicine had a 2.8% would die of their prostate cancer compared to 1.6% of men who had a very low risk of cancer progression who had surgical removal of their prostate glands.  The researches at John Hopkins found that the average increase in life expectancy after surgical removal of the prostate gland was only 1.8 months and that the men on active surveillance would remain free of treatment for an additional 6.4 years as compared to men who had immediate treatment with surgery on their prostate glands. 

Bottom Line: Men need to have a discussion with their physicians about the benefits and risks of prostate cancer screening.  Men with a life expectancy in excess of 20 years or younger men who have low risk disease may accept the risks of treatment rather than take the chance their cancer will cause harm later.  Men with very low risk disease can take comfort that their disease can safely be managed by active surveillance.