Prostate Screening

Prostate Screening

Prostate cancer is a type of cancer that mostly affects older men. After skin cancer, prostate cancer is the most common cancer in men.

Many men have questions about prostate cancer screening (testing). Even though prostate cancer is common, screening for it isn’t recommended. The information below can help you start a conversation about prostate cancer with your doctor or nurse.

What is the prostate?
The male prostate is a small sex gland that makes fluid to carry sperm. It’s located below the bladder and in front of the rectum.

Who is at risk for prostate cancer?
Risk factors for prostate cancer include:
•    Being age 50 or older
•    Being African American
•    Having a father, brother, or son who had prostate cancer

Why isn’t screening recommended for prostate cancer?
Screening for prostate cancer isn’t recommended because the risks of screening and treatment outweigh the benefits.
•    Most of the time, prostate cancer grows so slowly that men won’t die from it or have any symptoms.
•    The treatment of prostate cancer is more likely to cause medical problems than the prostate cancer itself.
•    The screening tests for prostate cancer that are available now can’t tell if you have a cancer that will cause problems or not.

What do I ask the doctor?
Here are some questions you may want to ask your doctor or nurse:
•    Am I at risk for prostate cancer?
•    Are there things I can do to lower my risk for prostate cancer?
•    What are the benefits and harms (risks) of prostate cancer screening and treatment?
•    Are there any warning signs or symptoms of prostate cancer I should look out for?

American Cancer Society recommendations for prostate cancer early detection
The American Cancer Society (ACS) recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information. The discussion about screening should take place at:
•    Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
•    Age 45 for men at high 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 age 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).

After this discussion, those men who want to be screened should be tested with the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.

If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the patient’s general health preferences and values.

Assuming no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test:
•    Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years.
•    Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.

Because prostate cancer often grows slowly, men without symptoms of prostate cancer who do not have a 10-year life expectancy should not be offered testing since they are not likely to benefit. Overall health status, and not age alone, is important when making decisions about screening.

Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient’s health, values, and preferences.

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