By: Dr. Alexander Feigl
The challenge in prostate cancer is the identification of those cancers that are more aggressive. How to screen for prostate cancer has its controversies. One major goal for those identifying and treating cancer is to minimize testing. The ability to identify those cancers that are fatal would be ideal. The American Cancer Society and the American Urological Association have established screening criteria. They provide guidelines to follow in considering the need to evaluate a male if there are enough risk factors for prostate cancer in his history.
American Cancer Society:
Age 50 for men at risk of prostate cancer and expected to live at least more than 10 years.
Age 45 for men at higher risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than 65).
Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age.
American Urological Association Guideline Statements:
The panel recommends against PSA screening in men under the age of 40.
In this age group, there is a low prevalence of clinically detectable prostate cancer, no evidence demonstrating the benefit of screening and likely the same harms of screening as in other age groups.
The panel does not recommend screening in men between ages 40-54 years at average risk.
For men younger than age 55 years at higher risk, decisions regarding prostate cancer screening should be individualized. Those at higher risk may include men of African American race; and those with a family history of metastatic or lethal adenocarcinoma (e.g. prostate, male and female breast cancer, ovarian, pancreatic spanning multiple generations, affecting multiple first-year relatives and that developed at younger ages.
For men ages 55-69 years the panel recognizes that the decision to undergo PSA screening involves weighing the benefits of reducing the rate of metastatic prostate cancer and prevention of prostate cancer death against the known potential harms associated with screening and treatment. For this reason, the panel strongly recommends shared decision-making for the mean age 55-69 years that are considering PSA screening and proceeding based on a man’s values and preferences.
The greatest benefit of screening appears to be in men ages 55-69 years
Multiple approaches after a PSA test (e.g. urinary and serum biomarkers, imaging, risk calculators) are available for identifying men more likely to harbor prostate cancer and/or with an aggressive phenotype. The use of such tools can be considered in men with suspicious PSA levels to inform prostate biopsy decisions.
Screenings for prostate cancer, even though there are guidelines, should be individualized. The doctor and patient relationship is the best tool you have in deciding if tests for prostate cancer should be performed on you.
