Prostate cancer is the most frequently diagnosed cancer in men, after skin cancer, and the second leading cause of cancer death, after lung cancer. As many as 1 in 7 American men will develop it during their lifetime, with most cases diagnosed in men 65 years of age or older. Some prostate cancers progress quickly and cause death within months or a few years, but most grow slowly and never pose a health threat.
Screening for prostate cancer is important for men to discuss with their healthcare providers. Many complicated issues are involved:
- Current technology cannot tell a slow-growing cancer from a fast one, and the cancer may never affect a man's health or life expectancy.
- Screening tests for prostate-specific antigen (PSA) do not detect all cases, and many positive PSA results do not prove to be cancer.
- Diagnosis through biopsy (potential infection and bleeding) and side effects of treatment (impotence and incontinence) can be more harmful than the cancer itself. Most prostate cancers are slow-growing and may not cause any trouble.
- Results from long-term trials on whether PSA testing improves prostate cancer survival rates have been inconclusive.
In spite of the questions surrounding prostate cancer screening, most health organizations agree that men should receive balanced information about prostate cancer screening and recommend that men discuss it with their healthcare provider. You need to know the risks, uncertainties, benefits, and limits of prostate cancer testing and treatment and should work with your healthcare provider to understand your options and decide what is best for you. Before choosing prostate screening, you should weigh the pros and cons based on your age, life expectancy, family history, race, overall health, previous test results, and individual risk tolerance.
One important factor to consider is your personal risk of developing prostate cancer:
- Average risk: Healthy men with no known risk factors
- Increased risk: African American men or men who have a father or brother who was diagnosed before they were 65
- High risk: Men with more than one relative who was affected at a young age
If you choose to undergo screening, the following tests may be recommended:
- Prostate specific antigen (PSA)—blood test that measures the level of PSA in the blood
- Digital rectal exam (DRE)—part of a physical exam that the health practitioner performs to examine the prostate gland
Most organizations do not recommend prostate cancer screening for men 49 and younger, unless they have increased or high risk. The exception is the National Comprehensive Cancer Network.
- The National Comprehensive Cancer Network recommends a baseline test at age 45 for men who want screening, which will determine when and how often to have future tests. It advises using the DRE and the PSA test, in combination, for the broadest detection of cancer in its early stages. If the result is greater than 1.0 ng/mL, or the man is higher risk, it recommends an annual DRE and PSA test.
- The U.S. Preventive Services Task Force (USPSTF) advises against PSA screening in men of any age, concluding that screening does not improve survival rates for prostate cancer for healthy men. The decision is based on the harm that can come from diagnoses that lead to false-positive test results or harm from the treatment of cases that are slow-growing and non-lethal.
- The American Cancer Society (ACS) recommends that healthy men with average risk who wish to be screened consider waiting to get tested until age 50. The ACS recommends considering earlier testing for higher-risk groups.
- If you are African American or have a father or brother who was diagnosed before they were 65, the ACS recommends considering starting testing at 45 years of age.
- If more than one relative was affected at a young 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 ACS recommends re-screening every two years if your PSA level is less than 2.5 ng/mL and annual screening if it is 2.5 ng/mL or higher.
- The American Urological Association recommends waiting to have a baseline PSA and DRE done at age 55 for men who wish to be screened. For those at increased or high risk, the group advises that decisions regarding prostate cancer screening be individualized based on patient preferences and an informed discussion about benefits and harms.
- The American College of Physicians advises screening men 50-69 years old who request to be screened.
National Cancer Institute: Prostate Specific Antigen Test Fact Sheet
National Cancer Institute: Screening and Testing to Detect Prostate Cancer
American Cancer Society: Prostate Cancer, Should I be tested?
Ottawa Health Research Institute: Decision Aids
Sources Used in Current Review
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