Your Guide To The New Prostate Screening Guidelines

Prostate Cancer Screening Guidelines

The new guidelines on prostate cancer screening have left some men wondering what they should do. Here’s a quick breakdown on what the US Preventative Services Task Force recommends.

Prostate cancer is the 3rd leading cause of cancer death in men in the US, with about 1 in seven men being diagnosed in their lifetime.   You may have recently heard the news that, despite previous cautions against getting screened for prostate cancer, new recommendations from the US Preventative Services Task Force are now recommending that men ages 55 to 69 at least have a discussion about prostate-specific antigen (PSA)-based screening, including the risks that go along with it.  So, what’s the deal? Will the test help or hurt you?

It depends. Back in 2012, the USPSTF recommended no routine screening at any age, because of the potential harm that could result after testing, including:

  • False Positives: A fair amount of PSA testing has suggested that prostate cancer may be present when there is in fact no cancer. Elevated PSA levels can be caused by many other things that don’t have anything to do with cancer. This can lead to worry and anxiety, and follow up tests that may not be needed.
  • Risk of infection with additional tests. In order to dig deeper after a PSA test, follow-up tests are done, which can potentially cause complications (fever, infection, bleeding, urinary problems, and pain).
  • Even if prostate cancer is diagnosed correctly, it sometimes never causes a problem for men. However, it’s difficult to tell what cancers will, or won’t be an issue later on, so most of the time, aggressive treatment is performed.
  • Treatment for prostate cancer can lead to other side effects, including erectile dysfunction, or urinary or fecal incontinence.

Due to these potential risks, the USPSTF recommended against screening men, since the benefits of screening really didn’t really outweigh the expected harm that could result. What has changed? 

The US Preventative Services Task Force now recommends that men ages 55 to 69 years of age should talk with their doctor about the potential benefits and harms of PSA screening for prostate cancer, and should make individualized decisions on how to proceed. This decision was made after determining that the potential benefits and harms of PSA tests are closely balanced in men ages 55 to 69. However, men over 70 are still recommended to not receive PSA screening.

Really, what all this boils down to is you. No longer should you just ignore the test if you are within the 55-69 age range. After all – it has been shown that of 1,000 men screened, testing may prevent up to 1 to 2 deaths from prostate cancer and up to 3 cases of metastatic prostate cancer over the course of 13 years.

But, you should weigh your options. Have an open dialogue with your doctor about your specific risks – your background and health history, your lifestyle, your healthcare beliefs and wishes – these are all important factors to take into consideration when deciding if and when to get tested.

You should also talk with your doctor about what the course of action would be if your PSA levels do turn out to be on the high side. While this could be a sign of cancer, it may also be caused by something else, such as enlarged prostate, which can be treated.

In the end, the Task Force is really just recommending a discussion. Which is something you should be having with your doctor anyway. Talk with your doctor about the risks so that together you can make an educated decision about your options.

Prostate Cancer: The Case For Watchful Waiting

Prostate Cancer; The Case For Watchful Waiting

Prostate cancer is one of the leading cancer causes of death in men in the US.  The American Cancer Society estimates that approximately 1 in 7 men will be diagnosed with prostate cancer in his lifetime.  But, while this is a widespread condition, and treatment is sometimes warranted, the medical industry has begun to see a shift in the prostate cancer treatment, choosing to actively monitor patients over time instead of choosing to perform surgery or conduct radiation immediately.  This treatment path is called “watchful waiting”, and is becoming more and more common for men with prostate cancer.

To understand why watchful waiting is becoming a more popular trend, let’s back up a bit and explain a little more about the diagnosis of prostate cancer.  The average age of men diagnosed with prostate cancer is 66 years old.  Common treatment options for prostate cancer have included medication, surgery to remove the prostate, chemotherapy, radiation, and even hormone therapy.  And while these treatments have become more and more effective over the years, they cause unwanted side effects (such as incontinence and impotence) and pose serious risks (like blood clots in the legs and lungs, heart attack, pneumonia, and infections.)

There has been much debate around whether or not the benefits of treatment outweigh the added side effects and risks that are introduced when one undergoes these types of therapies.  Additionally, it is not clear if these treatment options will completely eliminate the cancer.  For those patients who are low risk, the benefit of aggressive treatment compared to the potential side effects may just not be worth it. 

What types of patients may be good candidates for watchful waiting?  Those who are not seeing any symptoms from the cancer, those whose cancer is small, and located only in the prostate, and those whose cancer is expected to grow slowly all may benefit from this type of treatment. 

Additionally, older men who have a life expectancy of less than 10 years may not benefit from the added years that surgery can offer, making them a better candidate for watchful waiting. 

However, if the cancer is growing steadily, or spreading beyond the prostate, more aggressive treatment is usually recommended.  Men who are diagnosed young may also benefit from more aggressive treatment, as there is a greater chance that the cancer may grow worse over a longer span of time.

Whatever stage you are at, only you and your doctor can decide what is best for you.  Be sure to talk with him or her about the risks and benefits associated with each treatment path prior to making a final decision.