What’s the skinny on screening for prostate cancer

I am frequently asked by patients about screening for prostate cancer with PSA testing.  This article will discuss the evidence as well as my recommendations for my patients.

Despite ongoing debate over the value of prostate cancer screening, a new review says PSA screening can indeed reduce a man’s risk of dying from the disease.

Early cancer detection using the prostate-specific antigen (PSA) blood test lowers a man’s risk of prostate cancer death by 25 percent to 32 percent.  This is latest findings of two major trials of PSA testing found.

The amount of early diagnosis was very strongly correlated with the reduced risk of prostate cancer death.  That’s the favorable finding, however, there’s still a good chance that many men will be treated for prostate cancer that would not have killed them.  Most prostate tumors are slow-growing, and most men with prostate cancer wind up dying of heart disease or some other cause.

There are definitely harms associated with treatment which include erectile dysfunction and urinary incontinence, both are devastating consequences of treatment.

PSA testing requires a discussion between patient and doctor

Because of this, the decision about PSA screening will continue to be an individual choice for each man, that is best achieved with a discussion with your doctor.

Until about 2008, many doctors and medical societies encouraged yearly screening for men aged 50 and older using the PSA test, which examines blood for a protein produced by cells of the prostate gland, according to the U.S. National Cancer Institute. Elevated PSA levels often occur in men with prostate cancer.  Also elevated PSA levels occur in men with enlarged prostate glands from benign causes and prostate infections.

In 2009, a pair of long-awaited clinical trials on the testing — one from Europe, the other from the United States — were published.

Unfortunately, the trials provided confusion rather than clarity. The U.S. trial reported no benefit of PSA testing, while the European trial found a 20 percent reduced risk of death in men who underwent the screening, Etzioni said.

As a result, the U.S. Preventive Services Task Force (USPSTF) made the controversial move in 2012 to recommend against PSA testing altogether. Other groups, like the American Cancer Society, recommended that doctors share information from the clinical trials with men and let the patients decide.

Recent evidence of two trials wound up with very similar results. The U.S. trial showed a 27 percent to 32 percent lower risk of prostate cancer death thanks to screening, while the European trial showed a 25 percent to 31 percent reduced risk.  Therefore, both groups reflected a benefit of screening.

Bottom Line:

My advice is similar to the American Cancer Society, where men aged 55 to 69 could choose PSA testing after consulting with a doctor. I do not recommend screening men aged 75 or older.  However, men who are at risk for prostate cancer such as African American men and men with a close family member, father, brother, uncle, with prostate cancer should probably start screen after age 45 and then yearly thereafter.

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