Is Prostate Cancer Screening Right for Everyone?
In honor of it being Movember I wanted to take a look at prostate cancer and the controversy surrounding prostate cancer screening.
Prostate cancer is a common and frequent cause of death in males. In 2016, we expect the US to have 181,000 new prostate cancer diagnoses and approximately 26,100 prostate cancer deaths.
We screen for prostate cancer with digital rectal exams and the PSA blood test. Varied opinions and controversy exist regarding the digital rectal exam and PSA screening. Recommendations not only vary among physicians but also vary for prostate cancer screening among the American Urological Association, The United States Preventive Services Task Force, and the American Cancer Society.
PSA is controversial due to uncertainty as to whether the benefits of screening ultimately outweigh the risks of over diagnosis and over treatment.
The uncertainty lies in when and who to screen in order to reduce the number of patients that are found to be false positives, that is, the patient has an elevated PSA but no prostate cancer.
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Elevated PSA levels frequently lead to prostate biopsy. Prostate biopsy can lead to complications such as serious infections, urologic complications, or bleeding.
It is clear that routine prostate cancer screening is not for everyone. In fact, most men who choose not to have PSA testing will not be diagnosed with prostate cancer and will die from some other cause. The reason for this is that prostate cancer often grows so slowly that most men die of other causes before the disease becomes clinically advanced.
What is also clear is that appropriate prostate cancer screening does save lives. Appropriate screening for patients at risk is beneficial, specifically screening patients with a family history of prostate cancer, African-American race, increasing age, PSA blood test that is higher than expected for one’s age, and a rising PSA blood test, even if the PSA level is within normal range.
Additionally, patients with symptoms should be screened. These symptoms include blood in the urine, slow or frequent urinary stream, painful urination, or pain or blood with ejaculation.
How do we screen for prostate cancer?
In the primary care setting we screen by asking questions about symptoms, digital rectal exam and the PSA blood test.
My recommendation is to have a clear discussion with your primary care physician in your early 40’s to identify your specific risk factors for prostate cancer. In general, schedule routine prostate cancer screening starting at age 45 for a baseline PSA level and then determine the need for yearly screening with digital rectal exam and PSA based on your specific risk factors.
The best advice I can give to help clear the controversy is to spend time speaking with your primary care physician to identify risk factors or symptoms and develop a screening regimen that is right for you.
Part of our Personalized Medical Care membership includes a thorough annual exam and Dr. Espinosa helps monitor and recommend when prostate cancer screening in Atlanta is right for you.