Prostate Cancer

Each year 600,000 people die of cancer in the U.S.  That’s the bad news.  The good news is the cancer death rate is falling for prostate cancer, colorectal cancer, lung cancer, and breast cancer, which are the major cancer killers.

Prostate cancer

Prostate cancer is the second-leading cause of cancer in American men, behind only skin cancer. The more a man knows and understands what prostate cancer is and knows what he is dealing with, the more he can improve his chances of recovery.  According to the National Cancer Institute, approximately 14% of men will be diagnosed with prostate cancer at some point during their lifetime.  It can be deadly, but if it’s discovered in its early stages, it has a 98.9% survival rate.

Screening for prostate cancer is shrouded in controversy.  Different medical groups have different opinions regarding screening for prostate cancer.  Until 2012 the United States Preventative Services Task Force (USPSTF) advised against routine screening for prostate cancer using a simple blood test, the PSA or prostate specific antigen test.  The USPSTF recently revised their opinion regarding screening by suggesting that men 55-69 talk to their doctors about the advantages and disadvantages of screening.  That same task force recommends no screening is required for men more than age 70.

Appropriate screening especially in men with a family history of prostate cancer should be given the opportunity for having a screening PSA test.

PSA Screening

My opinion is that all men over age 50 should get a PSA test and based on the result then a decision can be made how often the man should receive follow up PSA testing.  For example, men with a PSA level less than 1.0, probably can be followed every 5 years rather than annually.

There are new approaches to disease management that minimizes potentially harmful treatments by having the man participate in active surveillance (AS).  AS consists of closely monitoring men with very low grade cancers rather than recommending treatment consisting of surgery or radiation therapy. There are also tests where the biopsy specimen can be used to determine which cancers are aggressive and require more aggressive treatment as opposed to less aggressive cancers and AS may be an appropriate management.

On the horizon is a “liquid biopsy” where doctors can identify cancers that might be more lethal through a urine test.  This test has the potential to evaluate genetic markers, proteins, and other molecules in order to advise men whether they need a biopsy and also will differentiate aggressive cancer from cancers that are less likely to cause harm.

Bottom Line: PSA screening is an appropriate method for detecting early prostate cancer when it is confined to the prostate.  Every man, especially those men who are at risk for prostate cancer, needs to have a discussion with their healthcare provider about the pros and cons of prostate cancer screening.


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