Screening Tests for Adults (50 and Up)

As many as 1 in 6 American men will develop prostate cancer during their lifetimes. Prostate cancer is the most frequently diagnosed cancer in males and the second leading cause of cancer death, after lung cancer. The strongest risk factor is age—it is rarely seen in men younger than forty while most cases are diagnosed in men 65 years of age or older.  It is more common in African-American men and in those with a family history of prostate cancer.

Some prostate cancers progress quickly and cause death within months or a few years, but most grow slowly and never pose a serious threat. Prostate cancer screening tests are an important subject for men to discuss with their health care providers. 

Expert panels have reached different conclusions about recommending universal screening for prostate cancer. Many complicated issues are involved:

• Side effects of treatment (impotence and incontinence) can be more harmful than the cancer itself (about 1 in 4 cancers is slow-growing and may not cause any trouble).
• Current technology cannot tell a slow-growing cancer from a fast one, and a man’s health or life expectancy may never be affected by the cancer.
• Tests for prostate cancer do not detect all cases, and about one third of positive results do not prove to be cancer.

Some groups urge testing because the majority of evidence, though not conclusive, shows that early detection of prostate cancer saves lives. Since the introduction of blood tests for prostate-specific antigen (PSA tests) in 1990, more prostate cancers are being caught before they spread to other organs and become difficult to cure. However, the experts do not have enough information to conclude that this is a direct “cause and effect” relationship.

Informed decisions
The National Cancer Institute, U.S. Preventive Services Task Force, American College of Preventive Medicine, and American Academy of Family Physicians have refrained from recommending for or against routine prostate cancer screening for men at low risk. They are concerned about doing more harm than good. Through studies being conducted over the next 5 to 10 years, the medical community hopes to shed light on the issues so that firmer conclusions can be reached.

Most scientific and medical organizations agree that older and middle-aged men should receive balanced information about prostate cancer screening. This includes men with no known risk factors who have reached the age of 50 years and have a life expectancy greater than 10 years. They need to know the pros, cons, and limits of prostate cancer testing and treatment and should be helped to understand the risks and options. Both patients and health care providers are being advised to use “shared decision making” to determine if screening is appropriate for the individual.

Age recommendations
For men who decide that screening is right for them, the American Cancer Society and American Urological Association offer the most rigorous screening guideline:

• Average risk: If you are of average risk, you can start getting tested at 50 years old. If you have risk factors, consider getting screened in your 40s. Citing evidence from various sources, the National Comprehensive Cancer Network suggests being more aggressive: men who want prostate cancer screening should consider getting a baseline PSA test at age 40.
• Increased risk: If you are of African descent or have a father or brother who was diagnosed at an early age, go for testing at 45 years (40, according to the National Comprehensive Cancer Network and the American Urological Association).
• High risk: If more than one relative was affected at an early age, you could begin testing at 40 years; then, depending on the results, get tested again at age 45 or earlier as results warrant.

The American Urological Association, National Comprehensive Cancer Network, and American Cancer Society advise using the digital rectal exam (DRE) and the PSA test, in combination, for the broadest detection of cancer in its early stages.

The American Cancer Society recommends that men 50 years of age and older who have a life expectancy of at least 10 years be offered both a PSA test and digital rectal exam each year.The U.S. Preventive Services Task Force says that testing once every other year may be as good as testing each year. However, the task force also, for the first time, published guidelines in 2008 recommending that such screening with PSA and DRE stop at age 75, citing concerns that the potential harms associated with screening outweigh the benefits of detecting prostate cancer early for those who are 75 and older or who have a  chronic medical condition or a life expectancy of less than 10 years.

A health care provider can help you weigh the pros and cons based on your age, life expectancy, family history, race, and previous test results.

Sources

American Cancer Society. Cancer facts and figures 2008. Available on the Internet at http://www.cancer.org/docroot/stt/stt-).asp through http://www.cancer.org. Accessed 20 Feb 2008.

Agency for Healthcare Research and Policy. Task Force Says Men Age 75 and Older Should Not Be Screened for Prostate Cancer. Available on the Internet at http://www.ahrq.gov/news/press/pr2008/tfproscanpr.htm through http://www.ahrq.gov. Issued August 4, 2008.

Lin LS, Sherin K and the ACPM Prevention Practice Committee. Screening for prostate cancer in U.S. men (ACPM position statement). Feb 2008. Am J Prev Med 34(2):164-170. PDF available for download at http://www.acpm.org/ProstateScreening_AJPM.pdf through http://www.acpm.org. Accessed 21 Feb 2008.

American Urological Association. Prostate cancer awareness for men. PDF available for download at http://www.auanet.org/guidelines/patient_guides/prostate_awareness.pdf through http://www.auanet.org. Accessed 21 Feb 2008.

American Urological Association. Prostate-specific antigen best practice policy. Feb 2000. Oncology 14(2). Available on the Internet at http://www.cancernetwork.com/journals/oncology/o0002e.htm through http://www.cancernetwork.com. Accessed 5 Aug 2004 and 20 Feb 2008.

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National Cancer Institute, National Institutes of Health. Prostate cancer (PDQ®): screening (summary of evidence). Available on the Internet at http://www.cancer.gov/cancertopics/pdq/screening/prostate/HealthProfessional through http://www.cancer.gov. 15 Dec 2003 version accessed 21 Jul 2004; 9 Jan 2008 version accessed 20 Feb 2008.

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National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: prostate cancer early detection. Available on the Internet at http://www.nccn.org/professionals/physician_gls/f_guidelines.asp#detection through http://www.nccn.org. Version 1.2004 accessed 5 Aug 2004; version 2.2007 accessed 20 Feb 2008.

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American College of Preventive Medicine. Screening for prostate cancer in American men: American College of Preventive medicine practice policy statement. 1998. Available on the Internet through http://www.medem.com. Accessed 5 Aug 2004 and 20 Feb 2008.

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