A hot topic in the news this year has been prostate cancer screening and the associated PSA (prostate specific antigen) test. There have been multiple recommendations from multiple sources in the past year or two, and it can be quite confusing to the public as to what to do. And there is controversy.
But as a urologist, I see men with prostate cancer or elevated PSA every day, and I feel that the newly released guidelines by the American Urological Association can help to address some of these controversies.
Since the late 1980s, the PSA test has been used to screen men for prostate cancer. Since that time, we have seen a steady decrease in the death rate from the disease, in part because the PSA test allowed us to find the cancer early enough to treat it. But last year, the U.S. Preventive Services Task Force recommended a wholesale abandonment of prostate cancer screening in men with no symptoms.
Why the change? Simply put, too much cancer screening can lead to unnecessary treatment for men who don’t need it, which can leave them with side effects such as bladder and bowel problems or sexual dysfunction.
Finding and treating early prostate cancer has helped that small percentage of men who would have died from it — but at the expense of treating many more men who wouldn’t have died while exposing them to the potential complications of diagnosis and treatment. Therein lies the controversy.
So, here are the new AUA guidelines, which do not call for wholesale elimination of prostate cancer screening but say it should be carried out only in men who are most likely to benefit from treatment.
How do you know if you’re one of those men?
For men 55 and younger — with no risk factors for prostate cancer — routine screening is not recommended. It is also not recommended in men 70 and older and/or if they have a life expectancy of less than 10-15 years.
What are the risk factors?
The most common are African-American race or having a family member with prostate cancer. If that’s you, screening beginning at age 40 may be a good idea. It’s important to discuss these risk factors with your doctor and then make a decision whether to be screened.
Another key component of the new AUA guidelines is an emphasis on “shared decision-making,” which means that the risks of screening and treatment, as well as the potential benefits, should be discussed.
The AUA also recommends screening occur every two years, rather than every year as previously recommended.
Another important consideration to remember is that these guidelines are for men who are asymptomatic, meaning they do not have urinary problems. While the presence of urinary problems is rarely caused by prostate cancer, it should be discussed with your physician and may influence the decision to screen for prostate cancer.
It’s important to remember that despite all the controversy, there are good scientific studies showing that screening asymptomatic men for prostate cancer does indeed save lives.
I hope this has helped clarify some of the controversies and questions surrounding prostate cancer screening. Talk to your doctor. Stay informed. Know your options.
Dr. Joseph Sonstein is an assistant professor in the department of surgery division of urology at the University of Texas Medical Branch at Galveston.