Posts Tagged ‘screening for prostate cancer’

 The Latest Advice on Screening for Prostate Cancer

August 6, 2017

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.



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. 


Guidelines for Prostate Cancer Screening

May 24, 2010

Men should discuss the benefits and risks of prostate cancer screening with their doctors, according to revised prostate cancer screening guidelines from the American Cancer Society (ACS). While this isn’t a radical change from the previous recommendations, the new guidelines offer clearer guidance on what should be discussed.

Difficulty determining who should be treated

Early prostate cancer is typically found using a PSA test and a DRE. Some prostate cancers grow slowly and may never cause a man any problems, while others are more aggressive and may spread to bones or other organs causing pain, discomfort, and even death.  Treatments for prostate cancer can have a lot of unpleasant side effects like incontinence and impotence that can really affect the quality of a man’s life.

Unfortunately, doctors can’t be sure which men need treatment and which would be fine without any therapy.

What the revised guidelines say

Because of these complex issues, the American Cancer Society recommends that doctors more heavily involve patients in the decision of whether to get screened for prostate cancer. To that end, ACS’s revised guidelines recommend that men use decision-making tools to help them make an informed choice about testing.

ACS recommends that men with no symptoms of prostate cancer who are in relatively good health and can expect to live at least 10 more years have the opportunity to make an informed decision with their doctor about screening after learning about the uncertainties, risks, and potential benefits associated with prostate cancer screening. These talks should start at age 50. Men with no symptoms who are not expected to live more than 10 years (because of age or poor health) should not be offered prostate cancer screening. For them, the risks likely outweigh the benefits, researchers have concluded.

As in earlier guidelines, ACS recommends men at high risk – African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65 – begin those conversations earlier, at age 45. Men at higher risk – those with multiple family members affected by the disease before age 65 – should start even earlier, at age 40.

For men who are unable to make a decision about screening after these conversations, ACS recommends the doctor make the call based on his or her knowledge of the patient’s health preferences and values.

For men who choose to be screened after discussing the pros and cons with their doctor, the new guidelines make the digital rectal exam (DRE) optional and offer the option of extending the time between screening for men with low PSA levels.  For example, for men less than 60 years of age who have a PSA less than 1.0ng\ml, they probably can get tested every 18 months to 24 months instead of every year.

Bottom Line: Prostate cancer is a common condition affecting nearly 225,000 men each year and causes 26,000 deaths each year.  Men should have a discussion with doctor about the benefits of PSA testing and then make the decision with all of the information to make an informed decision.

For more information contact the American Cancer Society (