Current Psa Screening Recommendations
PSA-based screening refers to testing healthy men without symptoms.
Until recently, physician societies disagreed on screening recommendations, but with the publication of the U.S. Preventive Services Task Force Guideline in May 2018, all the major physician groups are broadly in agreement, including the American College of Physicians , the American Cancer Society , American Urological Association , and American Society of Clinical Oncology :
- They advise supporting men so that they make informed decisions about screening that reflect their personal preferences and values.
- Routine screening is not recommended in men between ages 40 and 54 of average risk.
- For men ages 55 to 69 years, the U.S. Preventive Services Task Force concluded with moderate certainty that the net benefit of PSA-based screening is small for some men, making the decision up to the judgment of the physician and the values of the patient.”
- For men 70 years and older, they recommend against routine screening because the expected harms are thought to outweigh the benefits.
- Your doctor should not screen you unless you express a preference for it.
- A discussion of the benefits and harms of screening should include a family history of prostate cancer, race or ethnicity, any medical conditions that affect your overall health and lifespan, and your values about risk and benefit.
- If you have less than a 10-year life expectancy, screening is not recommended.
Psa Screening For Prostate Cancer: A Controversial History
The history of the role of the prostate-specific antigen test for prostate cancer is controversial.
The prostate-specific antigen blood test was created in the late 1980s, and tests for elevated levels of the antigen. Elevated levels can be suggestive of prostate cancer. The test itself is insufficient for diagnosing prostate cancer and was initially proposed as a marker of prostate cancer recurrence or disease progression. But doctors quickly began using it for cancer screening throughout the United States. By 1992, PSA testing as a cancer screen was at its peak.
Also, in the late 1980s, surgeons in the United States and Europe perfected the technique of radical prostatectomy, which involves removal of the prostate gland and any cancer within it. Initially, it seemed like an ideal situation: Men could have a simple blood test and prostate cancers that had not spread outside of the prostate gland could be cured.
But as time wore on, problems emerged that had not been anticipated when PSA screening was introduced:
Myth : It Is Futile To Treat Advanced Cancers As Most Men Die Soon Regardless Of Treatment
Unlike other cancers, prostate cancer, even in advanced stages, respond well to several modalities of treatment, with significant survival rates. With recent advances in hormonal therapy, the quality of life even in advanced prostate cancer can be good. Hence, treatment should be offered even in advanced prostate cancer.
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Bladder And Urinary Troubles
A prostate tumor that has grown significantly in size may start to press on your bladder and urethra. The urethra is the passage the carries urine from your bladder out of your body. If the tumor is pressing on your urethra, you might have trouble passing urine.
One of the common areas for prostate cancer to spread to is the bladder, because the two organs are close. This can cause additional problems with urination and bladder function.
Some symptoms your bladder and urethra are being affected by cancer include:
- urinating more frequently
- getting up in the middle of the night to pee
- feeling like you have to urinate often and not actually passing anything
Its not as common, but prostate cancer can also spread to your bowel. The cancer first spreads to the rectum, which is the part of your bowel closest to the prostate gland.
Symptoms of cancer thats spread to the bowels include:
Myth : I Do Not Have Prostate Cancer As I Do Not Have Any Symptoms
Early stage detection of prostate cancer can be tricky. Majority of prostate cancer cases are asymptomatic in early stages and become symptomatic only in advanced stages. Totally asymptomatic subjects have presented with complications like bone fractures due to metastatic cancer. So it is prudent to get evaluated based on the risk factors like a positive family history, diabetes, obesity etc.
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Is Early Onset Prostate Cancer Common
The average age for a first prostate cancer diagnosis is 68. In the U.S., about 10% of men newly diagnosed with prostate cancer are under 55. You may also develop prostate cancer when youâre much younger, in your teens or as a young adult, though this is extremely rare.
Around the world, thereâs been an increase in early onset prostate cancer in men between 15 and 40 years old.
Experts arenât sure why thereâs an increase. It may be related to certain risk factors. It may also be because of changes in how itâs diagnosed. Screenings are more frequent, and thereâs more awareness that prostate cancer can happen in younger men.
Causes Of Prostate Cancer
It’s not known exactly what causes prostate cancer, although a number of things can increase your risk of developing the condition.
These include:
- age risk rises as you get older and most cases are diagnosed in men and anyone with a prostate over 50 years of age
- ethnic group prostate cancer is more common among men and anyone with a prostate of African-Caribbean and African descent than in men and anyone with a prostate of Asian descent
- family history having a brother or father who developed prostate cancer under the age of 60 seems to increase the risk of you developing it having a close female relative who developed breast cancer may also increase your risk of developing prostate cancer
- obesity there may be a link between obesity and prostate cancer
- exercise men and anyone with a prostate who regularly exercises have also been found to be at lower risk of developing prostate cancer
- diet research is ongoing into the links between diet and prostate cancer a diet high in calcium is linked to an increased risk of developing prostate cancer
In addition, some research has shown that prostate cancer rates appear to be lower in men and anyone with a prostate who eat foods containing certain nutrients including lycopene, found in cooked tomatoes and other red fruit, and selenium, found in brazil nuts. However, more research is needed.
Read further information:
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Are There Complications Of Prostate Cancer And Treatment
Treatments can cause side effects, including:
- Erectile dysfunction: More than 3 in every 4 men have problems with getting and keeping an erection after surgery. However, this can be minimised using nerve-sparing surgery techniques. Erectile dysfunction is also common after radiation therapy and ADT. There are effective treatments for erection problems.
- Poor bladder control : 5% to 10% of men have problems with urine leakage within one year after prostate removal.
- Urinary urgency: Radiation therapy can cause damage around the prostate, making you feel like going to the toilet more often.
Men who take ADT may also experience a reduced sex drive and hormone-related effects such as hot flushes, tiredness and sweating, loss of body hair and osteoporosis. ADT can also result in reduced muscle strength, an increased risk of getting heart disease and memory loss.
/6multiple Treatment Options Available
Dougs cancer hadnt spread outside of the prostate and it was a fairly small tumour. The hospital first recommended that he go on active surveillance, in which they monitor the slow-growing localised prostate cancer, instead of treating it right away.
Few weeks later, the oncology team discussed and explained the available treatment options with Doug radiotherapy, chemotherapy, surgery or brachytherapy.
I opted for brachytherapy because I felt it was the least intrusive out of all the treatments, and I was adamant that I didnt want my prostate removed. It was also important to me to have the ability to go back to normal life quickly, Doug explained his treatment option.
In the LDR brachytherapy procedure, small radiotherapy seeds, about the size of a grain of rice, are inserted around the cancerous cells to eliminate them over a period of a few months.
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What Causes Early Onset Cancer
Itâs not yet clear why younger men get prostate cancer.
There seems to be a link between your genes and early onset prostate cancer. Researchers need to do more studies to see if things like obesity, physical activity, HPV infection, and exposure to things in the environment like cancer-causing agents play a role.
Does Prostate Cancer Have Any Symptoms
Most men with early prostate cancer dont have any signs or symptoms.
One reason for this is the way the cancer grows. Youll usually only get early symptoms if the cancer grows near the tube you urinate through and presses against it, changing the way you urinate . But because prostate cancer usually starts to grow in a different part of the prostate, early prostate cancer doesnt often press on the urethra and cause symptoms.
If you do notice changes in the way you urinate, this is more likely to be a sign of a very common non-cancerous problem called an enlarged prostate, or another health problem. But its still a good idea to get it checked out. Possible changes include:
- difficulty starting to urinate or emptying your bladder
- a weak flow when you urinate
- a feeling that your bladder hasnt emptied properly
- dribbling urine after you finish urinating
- needing to urinate more often than usual, especially at night
- a sudden need to urinate you may sometimes leak urine before you get to the toilet.
If prostate cancer breaks out of the prostate or spreads to other parts of the body , it can cause other symptoms, including:
- back pain, hip pain or pelvis pain
- problems getting or keeping an erection
- unexplained weight loss.
These symptoms can all be caused by other health problems. But its still a good idea to tell your GP about any symptoms so they can find out whats causing them and make sure you get the right treatment, if you need it.
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Genetic Testing For Prostate Cancer
You may hear a lot about genetics or genomics. Both terms are related to genes and cell DNA, but they are different. These tests are being used to learn more about the DNA of cancer cells, and link DNA mutations with treatments. In the future, genetic testing may be the first step doctors take when diagnosing prostate cancer.
Early Stage Prostate Cancer
If the cancer is small and localized, a doctor may recommend:
Watchful waiting or monitoring
The doctor may check PSA blood levels regularly but take no immediate action. Prostate cancer grows slowly, and the risk of treatment side effects may outweigh the need for immediate treatment.
Surgery
A surgeon may carry out a radical prostatectomy to remove the tumor. In addition to removing the prostate, the procedure may also involve the removal of the surrounding tissue, seminal vesicles, and nearby lymph nodes. A doctor can perform this procedure using either open, laparoscopic, or robot-assisted laparoscopic surgery.
Radiation therapy
This uses radiation to kill cancer cells or prevent them from growing. Options for early stage prostate cancer may include :
External radiation therapy: This method uses a machine outside the body to send radiation toward the cancer cells. Conformal radiation therapy is a type of external radiation that uses a computer to help guide and target a specific area, minimizing the risk to healthy tissue and allowing a high dose of radiation to reach the prostate tumor.
Internal radiation therapy: Also known as brachytherapy, this method uses radioactive seeds that a doctor implants near the prostate. A surgeon uses imaging scans, such as ultrasound or computed tomography to help guide the placement of the radioactive substance.
Treatment will depend on various factors. A doctor will discuss the best option for the individual.
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Tests For Prostate Cancer
There is no single test for prostate cancer. All the tests used to help diagnose the condition have benefits and risks, which your doctor should discuss with you.
The most commonly used tests for prostate cancer are blood tests, a physical examination of your prostate and a biopsy.
The blood test, known as a prostate-specific antigen test, measures the level of PSA and may help detect early prostate cancer. Men and anyone with a prostate are not routinely offered PSA tests to screen for prostate cancer, as results can be unreliable.
This is because the PSA blood test is not specific to prostate cancer. PSA can be raised due to a large non-cancerous growth of the prostate , a urinary tract infection or inflammation of the prostate, as well as prostate cancer. Raised PSA levels also cannot tell a doctor whether a man has life-threatening prostate cancer or not. This means a raised PSA can lead to unnecessary tests and treatment.
However, you can ask to be tested for prostate cancer once the benefits and risks have been explained to you.
How Do You Know If You Have Prostate Cancer
Theres no way of knowing if you have prostate cancer without visiting your doctor, as most men with early prostate cancer dont have any symptoms. And if you do have symptoms they can be caused by other things.
And you cant check for prostate cancer yourself.
You may want to speak to your GP if you’re over 50 , even if you don’t have any symptoms. These are all things that can increase your risk of prostate cancer. Your GP can give more information or tests if necessary.
If youre not sure about what to say to your GP, print and fill out this form and show it to them. This will help you have the conversation.
I thought I could be at risk after learning that African Caribbean men are more likely to get prostate cancer than white men.
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What Are The Treatments For Prostate Cancer
Your treatment options usually depend on your age, your general health, and how serious the cancer is. Your treatment may include one or more of options:
- Observation,which is mostly used if you are older, your prostate cancer isn’t likely to grow quickly, and you don’t have symptoms or you have other medical conditions. Your doctor will keep checking on your cancer over time so to see whether you will need to start treatment for the cancer. There are two types of observation:
- Watchful waiting means having little or no testing. If symptoms begin or change, you will get treatment to relieve them, but not to treat the cancer.
- Active surveillance means having regular tests to see if your prostate cancer has changed. If the tests show the cancer is starting to grow or if you develop symptoms, then you will have treatment to try to cure the cancer.
Expert Review And References
- American Cancer Society. Prostate Cancer Early Detection, Diagnosis, and Staging. 2019: .
- Garnick MB . Harvard Medical School 2015 Annual Report on Prostate Diseases. 2015.
- Hermanns T, Kuk C, Zlotta AR. Clinical presentation, diagnosis and staging. Nargund VH, Raghavan D, Sandler HM . Urological Oncology. Springer 2015: 40: 697-718.
- Logothetis CJ, Kim J, Davis J, Kuban D, Mathew P, Aparicio A. Neoplasms of the prostate. Hong WK, Bast RC Jr, Hait WN, et al . Holland Frei Cancer Medicine. 8th ed. People’s Medical Publishing House 2010: 94: 1228-1254.
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Patient Version. Bethesda, MD: National Cancer Institute 2020: .
- PDQ® Adult Treatment Editorial Board. Prostate Cancer Treatment Health Professional Version. Bethesda, MD: National Cancer Institute 2020: .
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Should Men At Elevated Risk Be Screened More Aggressively
It might sound logical to screen high-risk men earlier or urge men to adopt a healthy lifestyle to lower their risk for prostate cancer, but these areas have not been studied sufficiently. Therefore, physician organizations recommend more research and individualizing decisions about whether to get screened. Meanwhile, some leading organizations have issued recommendations, including:
- The American Urological Association The AUA recommends individualizing decision-making for men younger than age 55 who are high risk because they are African-American or have a positive family history. ” rel=”nofollow”> 7)
- The U.S. Preventive Services Task Force The USPSTF largely agrees largely with AUAs position and its 2018 recommendations are based on AUAs evidence review.
- The American Cancer Society The ACS takes this a step further, urging discussion about screening begin earlier for African-American men and men with first-degree relatives who have had prostate cancer.
Prostate Cancer Treatment Options: What Are They
Prostate cancer is, most often, a slow-growing cancer.
For some men, prostate cancer causes no symptoms or long-term issues, so treatment isn’t necessary.
In these cases, doctors may recommend active surveillance. That is, they’ll keep an eye on the development of the tumor using various tools and tests, including:
- Digital rectal exams
- Transrectal ultrasounds
- Prostate biopsies
Men who require treatment for their condition are most often treated with surgery, radiation therapy, hormone therapy, or a combination of these modalities.
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