What Every Man Should Know About Prostate Cancer Screening
By Ross A. Cohen, M.D.
Prostate cancer is the most common cancer among men (behind skin cancer), and the second leading cause of cancer death in men. One in six men will be diagnosed in his lifetime. In 2012, more than 240,000 men were diagnosed with prostate cancer and about 28,000 died of the disease. Prostate specific antigen (PSA) is a protein secreted by the prostate gland and is detected in the blood. Since the late 1980’s, PSA has emerged as the most important tumor marker for screening, detection, staging and monitoring of prostate cancer. This test when used with a digital rectal examination (DRE) of the prostate has been the mainstay of detecting prostate cancer in its earliest, therefore most curable stage. In May of 2013, the American Urologic Association released a new Clinical Practice Guideline on the Early Detection of Prostate Cancer.
The previous AUA recommendation was PSA testing and DRE annually for men 50 years or older. For African American men or men of any race with a family history of prostate cancer, testing was recommended to begin at age 40. The new guideline does not recommend routine screening in men of all ages, but, rather recommends that health care professionals utilize a more targeted approach to screening. The decision to test should be made in the context of a conversation between a man and his health care provider. The key points of the guideline include:
– Routine screening is not recommended in men under age 40.
– For men 40-54 there was insufficient evidence to recommend routine screening, and the decision to screen should be discussed with their provider.
– The greatest evidence of benefit of routine prostate cancer screening was found in men ages 55 to 69.
– Men with risk factors including race, family history or urinary symptoms should talk with their health care provider regarding testing.
– Routine screening is not recommended in men over the age of 70, or in men with a less than 10 – 15 year life expectancy. They also concluded, however, some men over age 70 could benefit from testing.
If prostate cancer screening is chosen, a PSA and DRE are performed by your health care provider. An abnormal PSA, DRE or both usually leads to a consultation with a Urologist. It is at this visit that it would be determined if further testing would be beneficial in diagnosing prostate cancer early, before it has spread. Transrectal ultrasound and biopsy to evaluate the prostate further and obtain tissue for diagnosis is usually the first diagnostic test. This is an office based procedure, performed under local anesthesia and is the only test that can truly differentiate prostate cancer from benign conditions of the prostate such as benign prostatic hypertrophy (BPH) or prostatitis.
If one is diagnosed with prostate cancer, the decision whether, when and how to treat it needs to be addressed. The treatment recommended depends on whether the cancer is thought to be localized (confined to the prostate) or if it is metastatic (spread beyond the prostate). This is usually determined with a CT scan or MRI of the pelvis and a Bone Scan. These are usually done at an imaging center. Treatment options must also take into consideration other factors including age of the patient, the presenting PSA, aggressiveness of the cancer on biopsy, the overall health of the patient, and the life expectancy of the patient.
The most appropriate treatment for localized prostate cancer continues to be debated. Treatment options for localized prostate cancer include:
– Watchful Waiting
– Robotic, laparoscopic or open radical prostatectomy
– External Beam radiation therapy
– Brachytherapy (high dose radiation or low dose seed implantation)
– Proton Beam Therapy
– Cyberknife
– Cryotherapy
– HIFU (High Intensity Focused Ultrasound)
Treatment options for metastatic prostate cancer include:
– Hormone therapy
– Chemotherapy
– Immunotherapy
Prostate Cancer screening carries with it potential benefits and risks. Benefits include stress relief if the screening is normal, minimizing the chance of cancer spreading if detected early and potentially helping some men live longer. Possible risks of screening include a “false negative” result in which some prostate cancers may be missed, a “false positive” result which can lead to needless stress and an unneeded prostate biopsy. In addition, treatment of prostate cancer can cause problems with erectile, urinary and bowel function. This is why men should discuss prostate cancer screening with their health care provider and see if it is right for you.
Ross A Cohen, M.D., is a Board Certified Urologist who has been in practice here in Palm Beach County for 23 years. His new office is located at 5065 State Road 7, Suite 203, Lake Worth, Florida. Call (561) 432-0067 to make an appointment or for more information.