Prostate cancer screening is available but is not necessarily recommended for all patients. There are benefits and risks to consider when screening for this cancer, and options should be discussed with a doctor.
Who should be screened for prostate cancer?
People with prostates may pursue screening through a prostate-specific antigen (PSA) blood test, and possibly a digital rectal exam (DRE), after an informed discussion with a physician about the benefits, potential harms, and limitations of screening.
The U.S. Preventive Services Task Force (USPSTF), an independent panel of experts that makes evidence-based preventive recommendations, suggests that people between the age of 55 and 69 have discussions with a medical professional about screening. For individuals older than 70, the USPSTF recommends does not recommend screening.
The American Cancer Society (ACS) recommends a similar approach. They recommend that people with prostates should begin screening discussions at:
- Age 50 for people who are at average risk of prostate cancer and are expected to live at least 10 more years.
- Age 45 for people at high risk of developing prostate cancer, including African American men and men with a first-degree relative who was diagnosed with prostate cancer before age 65.
- Age 40 for people with more than one first-degree relative who had prostate cancer at an early age.
Please note the differences between these guidelines. The ACS recommends an earlier discussion about screening for those at higher risk for the disease and specifies no age limit for screening to stop. A medical professional can help you determine what is right for you.
What are the potential benefits and risks of prostate cancer screening?
Decisions about screening are individualized because everyone’s risk of developing prostate cancer is different. In the right circumstances, prostate cancer screening can lead to an early diagnosis and curative treatment before it has spread.
However, screening may result in false positives and may lead to overdiagnosis and overtreatment. An elevated PSA level is not always associated with cancer and can be caused by other conditions such as an enlarged prostate (benign prostatic hyperplasia) and inflammation of the prostate (prostatitis).
An elevated PSA may lead to further procedures, such as a biopsy of the prostate, which in turn may lead to a diagnosis of prostate cancer. While discovery of prostate cancer may prove highly beneficial in some cases, even lifesaving, in other cases it may result in diagnosis of a problem that was destined to never cause harm. There are side effects associated with prostate cancer diagnosis and treatment, including risk of urinary incontinence and impotence among patients undergoing curative surgery.
The ultimate goal in prostate cancer screening is to promptly identify dangerous prostate cancers before they can cause harm, while avoiding the negative and unnecessary effects of overtreating unaggressive forms of the disease.
Work is ongoing to achieve this goal. Improvements in prostate cancer imaging, for example, can help identify which patients undergoing screening do require a diagnostic biopsy and which can be safely observed.
If a diagnosis of prostate cancer occurs, many patients are advised against aggressive, curative approaches such as surgery or radiation. It is increasingly appreciated that certain prostate cancers can be successfully managed with an active surveillance approach. In these ways, the harms associated with overdiagnosis are mitigated.
An informed discussion with a medical professional can help determine whether the potential benefits of curative treatment outweigh complications.
What factors contribute to prostate cancer risk?
The established risk factors for prostate cancer are:
- Age: The risk of prostate cancer increases with age, especially after age 50. About six in 10 prostate cancers are found after age 65.
- Race/ethnicity: Prostate cancer develops more often in African American men. The reasons for this difference are not clear and require further investigation.
- Family history: Prostate cancer has a strong heritable component. The risk of developing it approximately doubles if a father or brother has had it and is elevated if several relatives have been affected.
- Inherited gene changes: Certain gene changes (known as variants or mutations) can raise prostate cancer risk. Variants of the BRCA1 or 2 genes, which are linked to an increased risk of breast, ovarian, and other cancers in some families, can also increase prostate cancer risk. People with Lynch syndrome are at elevated risk for some types of cancer, including prostate cancer.
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.
While these observations may be generally helpful and scientifically accurate, if my 72 year old husband had followed his physician’s advice to skip prostate cancer screening (because he was too old to worry), he would not be alive today. Even after his PSA was found to be rising quickly, he was told that this was not cause for concern at his age. After insisting on follow-up, we found he had an aggressive cancer and, thanks to a clinical trial at DFCH, he is alive and well today.