To Screen or Not to Screen: The Latest News in Prostate Cancer

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Doctors are diagnosing fewer early-stage cases of prostate cancer, according to two recent studies published in the Journal of the American Medical Association. But it appears that the drop more reflects that fewer men are getting cancer screenings, not that that fewer men have cancer.

Prostate cancer screening was once part of men's regular medical checkups, like blood pressure and tests measuring cholesterol levels. But that lead to a problem: Regular PSA testing (standing for prostate-specific antigen, a protein associated with prostate cancer) for all men over 40 produced millions of false positives and subsequent painful biopsies and radiation treatments, which can cause erectile dysfunction and incontinence. To reduce the number of false positives and subsequent undesirable consequences, the US Preventive Services Task Force revised its guidelines in 2012, recommending against routine testing for men under 55. But the change might have been heeded too well — screening rates dropped by 18 percent between 2010 and 2013, the USPSTF found, and there's now some concern that men aren't checking themselves for this common cancer as often as they should.

"The challenge isn't just about PSA. The real key to prostate cancer isn't that we should or shouldn't be detecting it, but that we should be detecting it in the right people," says Dr. Robert Mordkin, chief of urology and director of robotic surgery at the Virginia Hospital Center, meaning patients with a family history of the cancer or a genetic disposition to it.  "Most important is becoming more sophisticated about selecting the right patient with the disease to treat and leaving the rest of those patients untreated, or at least in observation mode only."


Dr. Ahmedin Jemal, vice president of surveillance and health services research at the American Cancer Society, agrees. "The good news is that we're avoiding overdiagnoses and the complications that come with unnecessary treatments," he says, "but at same time we're missing the opportunity to detect lesions at the early stage."

So what should you do? While they search for tests with less risk than the PSA, experts agree that men should be way more involved in deciding whether they should get tested. Here are some guidelines that should help you from being over tested, or missing a life-saving visit to the doctor.

  • If you're under 40,  you don't need to be screened.
  • If you're 40 to 54 and are considered average risk, it's not recommended that you be screened.
  • If you're 55 to 69, discuss with your doctor whether you should be screened. It might not be necessary but the greatest benefit of screening is in this age group.
  • If you're over 70, screening isn't recommended.
  • If your father or brother died of prostate cancer, which doubles your risk,  and you're over 50, screening might be a good idea so discuss it with your doctor.
  • If you're African American and have a father, brother or son diagnosed with prostate cancer when they were younger than 65, you're considered high risk and should probably be screened.

 

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