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 has 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 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 when deciding whether to undergo screening 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 an early age
If you choose to be tested, 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
Recommendations: Ages 50 to 75 | Over age 75
In deciding which organizational guidelines you and your healthcare provider will follow, you should consider your own tolerances for risk and uncertainty and how you will use the test results.
- 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.
Several other organizations recommend screening only after men discuss the advantages and disadvantages of PSA-based screening for prostate cancer with their healthcare provider and make an informed decision.
- The American Cancer Society (ACS) recommends screening for men 50 years of age and older, with average risk and a life expectancy of at least 10 years who choose to be screened. The ACS recommends earlier testing for higher-risk groups. If you are in one of these groups, you may want to consider ongoing testing or starting it now.
- If you are African American or have a father or brother who was diagnosed before they were 65, you should begin testing now if you didn't start at the recommended age of 45.
- If more than one relative had prostate cancer at an early age, the ACS recommends testing begin at 40; then, depending on the results, retest at age 45 or earlier as results warrant.
The ACS recommends rescreening 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 (AUA) recommends a baseline PSA and DRE between the ages of 55 and 69 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 AUA recommends regular PSA and DRE testing regardless of whether your PSA was high or low or if the DRE was abnormal.
- The American College of Physicians advises screening men 50-69 years old who request to be screened.
- The National Comprehensive Cancer Network (NCCN) recommends a baseline test at age 45 for men who want screening, which will determine when and how often to have future tests. If you haven't yet had a baseline test, you may consider getting tested now. The NCCN 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.
Recommendations: Over age 75 | Ages 50 to 75
- The USPSTF recommends against screening men of any age, including those older than 75. It found that potential harms from prostate screening outweigh the benefits for men at an age where prostate cancer is not likely to cause death.
- The American Cancer Society and the American Urological Association emphasize that overall health, not just age, is an important consideration for older men when deciding to be tested. They recommend that men with a life expectancy less than 10 years not be tested, and the AUA does not recommend routine screening after age 70.
- The National Comprehensive Cancer Network emphasizes that men over 70 should receive individual consideration for their overall health, previous PSA results, family history, and risk factors before deciding to screen for prostate cancer and how frequently.
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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