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Having the power of choice can save your life, especially when it comes to prostate cancer screenings.
AdventHealth’s Medical Director of the Global Robotics Institute Vipul R. Patel, MD, FACS, explains, “If we don’t do PSA screenings we don’t find the cancer, and about 25,000 to 30,000 men will likely die from this disease. We must give men the choice of screening, so we can find cancer earlier when men can make more informed decisions about their health — and it starts with the PSA.”
This is supported by new recommendations for men with the BRCA2 gene mutation to get PSA (prostate-specific antigen) screenings starting at age 40 due to an increased risk of aggressive prostate cancer. If not screened, these cancers can go undiagnosed and lead to less favorable treatment outcomes.
But offering PSA screenings to men — and those with the BRCA2 mutation — isn’t that simple.
Challenges With Prostate Cancer Screening
According to Dr. Patel, “Prostate cancer screening has been somewhat controversial and confusing for patients, physicians and everyone alike. In the past, we used to recommend the PSA screening to everyone over age 50, but concerns about diagnosis of prostate cancer and over treatment of low-risk disease lead the U.S. Preventive Task Force to recommend against PSA screenings in 2012.”
Dr. Patel explains the current data on prostate cancer speaks loudly to the effects of pulling back on prostate screening recommendations. In fact, Dr. Patel helped lead a study published in 2019 that looked at 10,000 patients being treated with robotic surgery for prostate cancer. Their results mirror the national statistics, showing men are experiencing more significant prostate cancer disease.
“In men, prostate cancer is the most commonly diagnosed cancer and the second leading cause of cancer death. I see patients when they already have prostate cancer, so it’s too late for screening. Some of these patients, including some with the BRCA2 mutation, have advanced disease that could have been found earlier with screenings,” Dr. Patel details.
How BRCA2 Relates to Prostate Cancer
It’s been found that men with BRCA2 mutations have a higher risk of more aggressive prostate cancers at a younger age, but how would a man know that he has the BRCA mutation in the first place?
This, says Dr. Patel, is the conundrum.
“Aside from those that have a known family history of the BRCA2 gene mutation, a man might not find out he has it until he has a positive PSA and it leads to a prostate cancer diagnosis. Then, the next step can include genetic testing where a BRCA mutation is detected.”
This is an important step in treatment planning because genetic mutations increase the risk for more aggressive disease that requires treatment, where other types of prostate cancer are considered low risk and qualify for active surveillance.
Even further, Dr. Patel makes an important point. “The majority of men diagnosed with prostate cancer (even aggressive types) don’t have genetic mutations. There are more people with high-risk aggressive prostate cancer that don’t have BRCA mutations compared to those who do. Thus, a BRCA mutation is not a prerequisite for high-risk prostate cancer. So, we can’t ignore this population without genetic mutations in our screening recommendations.”
But the cornerstone of it all is the PSA screening.
So Who Should Get a PSA?
As one of the world’s leading prostate cancer surgeons — performing more robotic surgeries than any other surgeon worldwide, including more than 13,000 robotic prostatectomies to date — Dr. Patel offers these general guidelines for those who should consider prostate cancer screening:
- Men over age 50
- Men over 40 that are at a higher risk, such as African Americans, men with a family history of prostate cancer and men with a known BRCA2 mutation
Ultimately, every man is advised to talk to his primary care doctor about his prostate cancer risk and personalized screening recommendations.
Making the PSA Something to Talk About
“We have to make PSA screening something that men and their primary care doctors are discussing again. It’s a simple blood test that can be added to your yearly bloodwork,” Dr. Patel says.
“Within AdventHealth, our own guidelines encourage recommending PSA screenings to men. And in our practice, we’ve done a good job identifying those men at low risk who may elect to watch and wait with our active surveillance, as well as those at higher risk with more aggressive disease who could benefit from treatment.”
Dr. Patel’s main message is clear: “If we take away screening, we take away the choice. People should have the choice.”
Learn more about Dr. Patel’s expert urology team and the AdventHealth Global Robotics Institute.