Regional Cancer Center ~ Erie, PA

Should I Be Screened for Prostate Cancer?

Sep 08, 2015 | Posted in News

psa-test

The question of screening is a personal and complex one. It’s important for each man to talk with his doctor about whether prostate cancer screening is right for him.

There is no unanimous opinion in the medical community regarding the benefits of prostate cancer screening. Those who advocate regular screening believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects.

Those who recommend against regular screening note that because most prostate cancers grow very slowly, the side effects of treatment would likely outweigh any benefit that might be derived from detecting the cancer at a stage when it is unlikely to cause problems.

Recent studies of screening in large U.S. and European populations have suggested that the benefits of screening may not occur for 10 or more years after screening, given the long natural history of prostate cancer. These studies also suggest that many men will need to be screened (over 1,000) and treated (nearly 50) to save one life from prostate cancer.

In 2012, the U.S. Preventative Task Force recommended against the use of PSA screening for healthy men of all ages, stating that the harms of screening outweigh the benefits. In contrast, physician-led groups, such as the American Society of Clinical Oncology and the American Urological Association, maintain that PSA screening should be considered in the context of a man’s life expectancy and other medical conditions. Most experts agree that there is no role for PSA screening for men expected to live less than 10 years. Ultimately, decisions about screening should be individualized based on a man’s level of risk, overall health, and life expectancy, as well as his desire for eventual treatment if he is diagnosed with prostate cancer.

The American Urological Association (AUA) Foundation changed and updated it's screening recommendations on May 3, 2013. Better cancer specific blood and urine based tests are on the horizon. The PSA test remains an important tool in the diagnostic process. Men over 40 should discuss PSA screening with their physicians to determine if and when PSA screening is right for them, based on health and family history factors, they differ from those of the U.S. Preventive Services Task Force (USPSTF).

It should be noted that these recommendations apply to screening only, i.e. testing of healthy men without symptoms. Once the diagnosis of prostate cancer is confirmed by biopsy, PSA is still routinely recommended and used for risk-assessment and post-treatment monitoring.

Screening and Biopsy

A prostate cancer screening may reveal results that prompt a doctor to recommend a biopsy. There are many other supplementary tests and considerations that can help a man who is undergoing screening decide if a biopsy is necessary, including:

  • Lower vs. higher free PSA test
  • PSA velocity (rate of rise over time)
  • PSA density (PSA per volume of prostate)
  • Family history
  • Ethnicity
  • Prior biopsy findings
  • Digital rectal exam results
  • Different forms of PSA (i.e. bPSA, pro-PSA)

In general, a lower free PSA (percentage) indicates a higher risk of finding cancer at biopsy, as does a higher PSA velocity and PSA density.

Discuss these individual tests with your doctor to make screening decisions that are best for you.

Learn more about Prostate cancer prevention and treatment here

Source: Prostate Cancer Foundation

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