Prostate cancer screening options are available but are not necessarily recommended for all patients. There are positive and negative factors to consider when screening for this cancer, and options should be discussed with a doctor.
Who should be screened for prostate cancer?
The U.S. Preventive Services Task Force (USPSTF) recommends that people with prostates between the age of 55 and 69 screen for prostate cancer after discussing and reviewing benefits, harms and limitations of screening with their doctor. The USPSTF recommends against screening for people age 70 and older.
The American Cancer Society (ACS) also recommends that men discuss with their health care provider the uncertainties, risks, and potential benefits of prostate cancer screening. This discussion 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, specifically African American men and men with a first-degree relative (father or brother) who was diagnosed with prostate cancer at an early age (younger than age 65).
- Age 40 for men with more than one first-degree relative who had prostate cancer at an early age.
After this discussion, men who want to be screened should get the prostate-specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.
Please note the differences between these guidelines. The ACS recommends earlier screening for those at highest risk of the disease. In addition, the ACS specifies no upper age limit at which to discontinue screening. Rather, life expectancy could determine when yearly or bi-annual screening ends.
What are the potential benefits and drawbacks of prostate cancer screening?
In the right circumstances, prostate cancer screening can lead to an early diagnosis and curative treatment before it has spread. However, prostate cancer screening is not always appropriate for individuals in the 55 to 69 age range. In many cases, prostate cancer does not have an impact on a person’s lifespan: in fact, the American Cancer Society (ACS) reports that for most older patients, prostate cancer is often a chronic, non-life threatening disease.
While aggressive, curative treatment is critical for many men with prostate cancer, there are side effects associated with prostate cancer diagnosis and treatment:
- A prostate cancer diagnosis can cause the following mental and physical issues.
- An elevated PSA level is often not associated with cancer, but other conditions, such as an enlarged prostate (benign prostatic hyperplasia) and inflammation of the prostate (prostatitis). As a result, positive screening results usually require a further, usually invasive, procedures such as transrectal ultrasound-guided core-needle biopsy of the prostate to diagnose prostate cancer.
- Problems such as incontinence and impotence are possible with prostate cancer treatment. Since many prostate cancers are not very aggressive, a medical professional can help determine whether the potential benefits of curative treatment outweigh these potential complications.
Therefore, it is important to avoid overdiagnosis and overtreatment whenever possible.
Patients should consult with a medical professional in order to make the most informed decisions regarding screening and treatment.
What risk factors can contribute to prostate cancer?
The established risk factors for prostate cancer are age, race/ethnicity, and family history:
- Age: The risk of prostate cancer increases with age, and the incidence begins to rise “sharply after age 55 and peaks at age 70-74, declining slightly thereafter,” according to a 2002 study.
- Race/ethnicity: Men of West African ancestry are more likely to be diagnosed with prostate cancer than men of other ancestral groups. While prostate cancer is less common in Asian Americans and Hispanic/Latino men than in non-Hispanic whites, disease rates in these populations may be increasing.
- Family history: Prostate cancer is largely an inherited disease. About 60% of prostate cancer risk is inherited from one’s parents and about 40% is due to environmental and lifestyle factors.
About the Medical Reviewer
Dr. Mark Pomerantz is a medical oncologist at the Dana-Farber Cancer Institute. Dr. Pomerantz received his undergraduate degree from Yale University and his medical degree from Stanford University. He trained in Internal Medicine at Brigham and Women's Hospital in Boston, Massachusetts. He then pursued a fellowship in Medical Oncology at the Dana-Farber Cancer Institute in Boston. Dr. Pomerantz received his post-doctoral training in cancer genetics with Dr. Matthew Freedman at the Dana-Farber Cancer Institute and the Broad Institute of Harvard and MIT. He is on faculty at the Dana-Farber Cancer Institute in the Lank Center for Genitourinary Oncology.