Prostate Cancer Screening

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Prostate cancer is the most common internal malignancy and second-leading cause of cancer-related death in American men. Approximately 12% of men will be diagnosed with prostate cancer in their lifetime.

Many men have heard about prostate cancer but are probably not familiar with the details surrounding prostate cancer screening. Over the past decade, there has been controversy about screening for prostate cancer, however, evidence suggests that it has a positive benefit in preventing prostate cancer deaths.

Guidelines vary, but in general, men should be screened for prostate cancer starting around age 50. This is typically done with a blood test, called a PSA (prostate specific antigen) and an exam. It can be performed by a primary care physician or a urologist.

Some men may benefit from earlier screening, starting around age 40. Those include men who have a family history of prostate cancer, African ancestry or a known genetic predisposition. Certain genetic mutations, such as BRCA mutations (traditionally associated with breast cancer) are known to increase the risk of prostate cancer. Patients should be aware of their family history, and if there is any of the following, they should speak to their physician regarding early screening:

  1. First- or second-degree relative with metastatic prostate cancer, ovarian cancer, or breast cancer diagnosed (45 years of age or younger)

  2. Colorectal or endometrial cancer (50 years old or younger)

  3. Two or more first- or second-degree relatives with breast, prostate, pancreatic, colorectal or endometrial cancer at any age

Sometimes, a man’s PSA may be temporarily elevated for other reasons, such as infection, inflammation or sexual activity. The first step is to repeat the PSA. If any patient has a PSA over 3 on at least two lab tests or an abnormal exam, they should be referred to a urologist. Generally, at this point, a prostate biopsy is recommended. While other tests, such as prostate MRI, are available to help guide decision-making in patients with an elevated PSA, only a biopsy can definitively say whether cancer is present. Even patients with a negative prostate MRI should still undergo a biopsy if their PSA is persistently elevated – this is because a prostate MRI can sometimes miss cancer.

If prostate cancer is detected on a biopsy, shared decision-making between the patient and the urologist is performed. Close observation – called “active surveillance” - or treatment may be recommended depending on the aggressiveness of the cancer. Treatment for most men involves surgery or radiation, however, other treatments such as cryotherapy or high-intensity focused ultrasound (HIFU) may be recommended depending on the individual patient and their needs.

After ages 70 to 75, most men can discontinue prostate cancer screening. This is because we know prostate cancer is typically slow-growing, and after this age, patients are more likely to die with prostate cancer rather than from prostate cancer. Discontinuing screening at this age spares patients the side effects of treatment while maximizing the detection of a potentially life-altering prostate malignancy.

If you have any questions about prostate cancer screening, you should reach out to your primary care physician or urologist.

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