Screening for prostate cancer is a decision men often make based on risk factors such as age, race and family history. About one in six will be diagnosed during his lifetime, according to the American Cancer Society. However, about one in 36 will die from the disease.
In the summer of 2012, confusion arose when the US Preventive Services Task Force, a government advisory panel, recommended against prostate-specific antigen (PSA) testing regardless of risk factors.
The best option for reducing prostate-cancer related deaths over the past two decades has been an early diagnosis, leading to early detection at more treatable stages. Currently, the best screening method is a combination of PSA testing and a digital rectal exam (DRE). Additional, the use of genetic marker tests and MRI are also helpful.
PSA tests have been used for routine screening and detection since the early 1990s. Its a simple test for men over 40 as part of their annual blood work, says Vipul Patel, MD, urologic oncologist at AdventHealth.
Not all prostate cancers are deadly, and the PSA isn't perfect, but there's been a 40 percent reduction in mortality since testing began, he adds.
Additionally, many large trials have shown a significant reduction in deaths from prostate cancer in men who had early screenings with PSA.
Recently the AdventHealth Cancer Institute released the following PSA screening guideline:
- At 40, men with life expectancy greater than 10 to 15 years should consider screening.
Additionally, doctors should begin speaking with men about screening according to these risk categories:
- Very high risk (men with more than one first degree relative father, brother, son diagnosed with prostate cancer): Conversations at age 40
- High risk (men of African American descent and/or those with a single first-degree relative diagnosed before age 65): Conversations at age 45
- Average risk: Conversations at age 50
Screenings should include a PSA and DRE. For men whose life expectancy is less than 10 to 15 years, screenings should not be offered.
The exact interval of subsequent screenings is still uncertain, and the pros and cons of future screening intervals should be discussed individually. These recommendations have been adopted based upon the guidance of our AdventHealth Cancer Institute expert panel and with consideration of the American Cancer Society's Recommendations on Prostate Cancer Screening and the American Urological Association Guideline.