William Carter, MD at Roper Saint Francis discusses important new updates to Prostate Cancer Screening Guidelines and what you need to know to make sure you are protected.
One thing is clear about prostate cancer: the earlier it’s discovered and diagnosed, the better the survival rate. But what’s less clear, or so it seems to the typical man on the street, is how and when you should be screened?
Various organizations, including the U.S. Preventative Services Task Force (USPSTF) and the American Urology Association, have issued different messages over the last few years about the value of screening, the recommended ages and frequency for screening and which type of screening is best – a PSA (prostate specific antigen test) or a digital rectal exam (DRE).
We’ve gone from the USPSTF saying in 2012 that PSA was of no value for early detection, to the American Urology Association countering that one year later with a recommendation that a PSA screening “could be of value” to those men in the 55 to 70 age group. The panel stated “there is no evidence to show that screening prior to the age of 55 or after the age of 70 is of benefit,” however, this basically means there are no studies evaluating PSA screening in men under age 55 or older than 70. But let’s remember: Absence of evidence does not necessarily mean absence of an advantage for screening.
So where does this leave us in 2016, at a time when:
- We’re seeing more patients with more locally advanced, higher stage prostate cancer;
- The number of patients presenting with metastatic prostate cancer has dramatically increased;
- And every urologist in the Roper St Francis system has seen multiple new patients this year with the above difficult-to-cure or impossible-to-cure prostate cancers?
What we don’t want is to return to the pre-PSA era when getting a prostate cancer diagnosis meant much lower cure rates and increased end-of-life complications from advanced disease.
Today, my urology colleagues and I at Roper St. Francis suggest a modified screening guideline that is decided in “shared decision making” discussion with our patient, taking into account their risk factors and family disease history. Our guidelines recommend:
- A baseline screening PSA at age 40, along with discussion of the potential advantages/disadvantages of PSA screening.
- If the PSA was 1 or less, a repeat PSA should be obtained at age 45 and if still appropriately low, a third PSA at age 50. Additional PSA screening intervals would then depend on the PSA level and whether or not there had been progression of the PSA level.
- A DRE should remain a part of prostate cancer screening in addition to PSA.
With prostate cancer, as with every disease, prevention is the best medicine, so maintain a healthy diet rich in fresh fruits, vegetables, whole grains and nuts and low in red meat, processed meat and animal fat and exercise regularly. Maintaining a healthy body weight is important, as obesity is directly related to an increased incidence of prostate cancer, colon cancer, breast cancer, diabetes and heart disease.
And second to prevention, early detection is best when dealing with cancer, including prostate cancer, and screening is the best way to find prostate cancer early while it’s treatable.
If you or a loved one has questions or concerns about screening or treatment for prostate cancer, please call (843) 402-CARE for a free referral to a RSF affiliated urologist.
By William Carter, MD, Lowcountry Urology Clinics