PROSTATE CANCER SCREENING


Prostate cancer screening is controversial. On one hand, detecting prostate cancer early may allow for more treatment options with potentially fewer side effects. On the other hand, because most prostate cancers grow slowly, the side effects of treatment may outweigh any of the benefits of early detection.

 

Screening Tools

Because prostate cancer does not typically cause symptoms until advanced stages, two tests are currently used to detect the disease at earlier stages.

 

The first is the Prostate-Specific Antigen (PSA) Test. PSA is a protein produced by the prostate gland. The PSA test measures levels of PSA in blood, with a higher PSA level indicating a greater likelihood of prostate cancer.

 

The second test is a Digital Rectal Exam (DRE). In this exam, a doctor inserts a gloved finger into the rectum to feel for hard, lumpy, or abnormal areas on the prostate.

 

False-positives may occur in both of these tests. There is much evidence that PSA and DRE are best used together. As the PSA increases, the positive predictive value of the DRE also increases.

 

Screening Debate

Research on prostate cancer screening effectiveness reaches mixed conclusions. Two large randomized trials investigated the usefulness of screening men for prostate cancer with the PSA blood test. The first trial was conducted in the US and explored whether intensive (frequent) screening was more effective than opportunistic (in-frequent) screening at saving lives. The second trial was conducted across multiple countries in Europe and examined whether intensive screening was better than no screening at all. The US study did not find intensive screening to be better than opportunistic screening. However, it did find that intensive screening reduced prostate cancer related deaths in healthy men under age 65. Conversely, the European study found that intensive screening reduced prostate cancer mortality by 20-28%.  Importantly, the European study showed that this effect was most pronounced in Northern European countries including Sweden, Netherlands and Finland. 

 

See Dr Walsh and Dr Carter comments on the PSA screening trials

 

While oncologists agree that screening for prostate cancer can reduce prostate cancer mortality, it can come at the expense of over-diagnosis and over-treating men with non – life threatening cancers. 

 

Recommendations on when to Start Screening

 

The American Urology Association (auanet.org) recommends:
Discussions about PSA screening and shared decision making about screening should begin at age 55.  The AUA suggests that the greatest benefit of PSA screening is in men aged 55-69.
Individualized Prostate cancer screening for men under the age of 55 with a family history or of african descent.
For additional details please see: https://www.auanet.org/education/guidelines/prostate-cancer-detection.cfm

 

Prostate cancer screening is performed with a PSA blood test and a rectal exam.
The American Cancer Society (acs.org) recommends discussions about screening should begin at:

  • Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
  • Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
  • Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

 

The American Cancer society recommends that Prostate cancer screenign be performed annually if the PSA value is over 2.5 and every other year if the test is less than 2.5.
The American Cancer society does not recommend screening men who have a life expectancy of less than 10 years. 
For additional details please see: http://www.cancer.org/cancer/prostatecancer/moreinformation/prostatecancerearlydetection/prostate-cancer-early-detection-acs-recommendations

Please read New Options for Prostate Cancer Screening

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