Harms Of Screening And Subsequent Testing
Prostate cancer screening is associated with high rates of overdiagnosis and overtreatment, which lead to psychological and physical harms. Screening for prostate cancer can result in an increase in prostate cancer diagnoses of up to 63%.15
Elevated PSA levels often prompt interventions, mainly transrectal ultrasound-guided prostate biopsy. In the ERSPC, one in five men screened underwent a biopsy for a false-positive PSA test result.16 False-positives often lead to anxiety and persistent worry about prostate cancer.17
One-third of men who undergo prostate biopsy require physician follow-up for problems related to the procedure, which patients have classified as moderate to severe.18,19 These include pain and fever , hematuria , hematospermia , and hospitalization .18,20 Biopsy misses prostate cancer in 10% of cases, and repeat biopsy is needed in up to 31% of men who have an initial negative biopsy result.21,22
Most hospitalizations after prostate biopsy are related to infections, such as urosepsis or prostatitis. Although the overall rate for hospital admission after a prostate biopsy is 3%, one study found that the rate of hospitalization for Medicare patients is nearly 7%.23 Biopsy-related mortality is less than 1%, and most deaths within 30 days of PSA screening and associated procedures are because of comorbid conditions.
Prostate Cancer Risk Factors
A risk factor is anything that raises your risk of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like a persons age or family history, cant be changed.
But having a risk factor, or even several, does not mean that you will get the disease. Many people with one or more risk factors never get cancer, while others who get cancer may have had few or no known risk factors.
Researchers have found several factors that might affect a mans risk of getting prostate cancer.
Prostate Cancer Screening Recommended Earlier For Men With Family History Of The Disease
Researchers found that men with a family history of prostate cancer reached the screening risk threshold up to 12 years earlier than the general population.
A new study in Sweden has confirmed that men with a family history of prostate cancer have a greater risk of being diagnosed with advanced or fatal disease, suggesting that screening guidelines should be adjusted to include earlier screenings in this population.
Clinical guidelines for cancer screenings are intended to identify the disease early, according to the research, which was published in PLOS Medicine. Current guidelines note that men with a family history of prostate cancer have a greater risk and should begin screenings early, although the age at which these screenings should begin has remained unclear.
To define a recommended age, investigators conducted an analysis of all male residents of Sweden born after 1931, as well as their fathers. Between 1958 and 2015, they found that 88,999 out of 6,343,727 men were diagnosed with stage 3 or 4 prostate cancer or died from the disease.
These findings could be used to provide greater personalization of screening guidelines, according to the press release. Further research could help validate these results in populations of different ethnicities, while also considering genetics and lifestyle differences.
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Family History And Genetics
Your family history is information about any health problems that have affected your family. Families have many common factors, such as their genes, environment and lifestyle. Together, these factors can help suggest if you are more likely to get some health conditions.
Inside every cell in our body is a set of instructions called genes. These are passed down from our parents. Genes control how the body grows, works and what it looks like. If something goes wrong with one or more genes , it can sometimes cause cancer.
Is prostate cancer hereditary?
If people in your family have prostate cancer or breast cancer, it might increase your own risk of getting prostate cancer. This is because you may have inherited the same faulty genes.
My father had prostate cancer. What are my risks?
- You are two and a half times more likely to get prostate cancer if your father or brother has had it, compared to a man who has no relatives with prostate cancer.
- Your chance of getting prostate cancer may be even greater if your father or brother was under 60 when he was diagnosed, or if you have more than one close relative with prostate cancer.
- Your risk of getting prostate cancer may also be higher if your mother or sister has had breast cancer.
Do you have a family history of prostate cancer?
If you’re over 45 and your father or brother has had prostate cancer, you may want to talk to your GP. Our Specialist Nurses can also help you understand your hereditary risk of prostate cancer.
Early Detection Saves Lives
Prostate cancer is the most common cancer affecting Australian men .
Prostate cancer is the growth of abnormal cells in the prostate gland. This gland is only found in males and is about the size of a walnut.
The causes of prostate cancer are not understood and there is currently no clear prevention strategy.
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Understanding Your Psa Test Results
PSA is usually measured in nanograms per millilitre of blood . There is no one PSA value that is considered normal. The value varies from man to man and increases as you get older. Most men have a PSA level of less than 3ng/ml.
Your GP or specialist may suggest further tests if your PSA level is higher than would be expected for someone of your age. Talk to your doctor about your PSA level and what this means for you.
How Do I Get Tested
A general practitioner or an urologist can perform a full prostate cancer exam. This should include a PSA blood test and a digital rectal exam .
A Prostate-Specific Antigen blood test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions.
A Digital Rectal Exam is a physical exam that is done when a doctor or nurse inserts a gloved, lubricated finger into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities.
Talk to your general doctor or urologist about receiving a prostate exam. If you do not have a doctor, do not have insurance, or cannot afford a test, find out what free screenings are available in your area on our Free Testing Map. If you do not see a free screening in your area, check back in the fall. Many screenings occur in September, during Prostate Cancer Awareness Month.
Recent research has yielded additional tests that in addition to the PSA test and DRE and biopsy that can give a doctor more information on to determine the probability of both finding cancer during a biopsy and determining how aggressive that cancer is likely to be. Learn more here.
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Genetic Contribution To Inherited Prostate Cancer
Prostate cancer has a substantial inherited component estimated at 40%50% . This genetic contribution is made up of a combination of rare variants in genes of high- to moderate-penetrance and common, low-penetrance genes. However, the identification of susceptibility genes in prostate cancer has been challenging due to both the clinical and genetic heterogeneity of the disease.
Could You Have A Faulty Gene
Red flags that you may have inherited a gene that raises prostate cancer risk include:
- Multiple family members diagnosed with prostate cancer, especially before age 55.
- A family history of prostate cancer coupled with breast, ovarian, colon, or pancreatic cancer.
A simple blood test can help determine if you carry a worrisome gene. So be sure to share your familys cancer history with your doctor, Obeid advised. If appropriate, your doctor can refer you to a genetic counselor to help you decide if testing is right for you and to help you understand the results.
If genetic testing does reveal that you have an inherited risk of prostate cancer, early screening with a digital rectal exam and PSA blood tests could help doctors find any prostate cancer that develops and, if cancer is ever suspected, your doctor may recommend that a biopsy be performed. For men with an increased genetic risk for prostate cancer, biopsies may be recommended at a lower PSA level than usually is for those with no inherited risk.
Your family members might also want to consider genetic testing because they may have inherited the same abnormal gene.
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Harms Of Treating Cancers Detected By Screening
One-half of screening-detected prostate cancers will not cause symptoms in the patient’s lifetime, and 80% to 85% of men who choose observation will not die from prostate cancer within 15 years.14 In men who have low-risk disease, defined as a PSA level of less than 10 ng per mL, stage T1 or T2a cancer, and a Gleason score of less than 6, the 15-year prostate cancer mortality rate is less than 5%.14,24,25 Nonetheless, in the United States, approximately 90% of men diagnosed with prostate cancer decide to undergo curative treatment.26,27
Treatments aimed at curing the cancer include radical prostatectomy, external beam radiotherapy, and brachytherapy. Short-term adverse effects of radical prostatectomy include perioperative bleeding that may require blood transfusion, which occurs in up to 20% of patients. Complications arise within 30 days of radical prostatectomy in 22% of patients.28 The main long-term complications of prostatectomy are urinary incontinence and erectile dysfunction .14,25,29
Research Needs And Gaps
There are many areas in need of research to improve screening for and treatment of prostate cancer, including
- Comparing different screening strategies, including different screening intervals, to fully understand the effects on benefits and harms
- Developing, validating, and providing longer-term follow-up of screening and diagnostic techniques, including risk stratification tools, use of baseline PSA level as a risk factor, and use of nonâPSA-based adjunctive tests that can distinguish nonprogressive and slowly progressive cancer from cancer that is likely to become symptomatic and affect quality or length of life, to reduce overdiagnosis and overtreatment
- Screening for and treatment of prostate cancer in African American men, including understanding the potential benefits and harms of different starting ages and screening intervals and the use of active surveillance given the large disparities in prostate cancer mortality in African American men, this should be a national priority
- How to better inform men with a family history of prostate cancer about the benefits and harms of PSA-based screening for prostate cancer, including the potential differences in outcomes between men with relatives who died of prostate cancer and men with relatives diagnosed with prostate cancer who died of other causes
- How to refine active prostate cancer treatments to minimize harms
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What To Do If You Think You Are At Higher Risk Of Prostate Cancer
Speak to your GP if you think you are at higher risk of prostate cancer. For example if you:
- are a Black male or a Black person who has a prostate
- have a close relative, such as brother or father, who has prostate cancer
- have inherited certain genes which can increase the risk of prostate cancer
The risk of prostate cancer also increases as men get older.
The evidence so far suggests that routinely screening people who have a high risk of prostate cancer doesnt help prevent deaths. In fact, it might lead to men having treatment for prostate cancer even though that cancer wouldnt have caused any problems or symptoms.
Psa Test For Prostate Cancer
The prostate gland makes a protein called prostate specific antigen . This protein helps to nourish sperm. Normally, only tiny amounts of it enter the bloodstream.
Cancer cells in the prostate interfere with proper functioning and can cause large amounts of PSA to enter the bloodstream. Therefore, when high levels of PSA are detected in the bloodstream, this may indicate cancer.
Early prostate cancer often has no symptoms. However, high PSA levels can occur five to 10 years before the onset of prostate cancer symptoms. In such circumstances, the PSA test can help to indicate the presence of cancer at an early stage.
Other tests are needed to confirm a diagnosis because an abnormal PSA test can be due to non-cancerous causes. Equally, it is possible for a man to have a normal PSA level when cancer is present.
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Its Movember: Time To Check In On Prostate Cancer Screening
Prostate cancer is a common concern among male patients particularly as they get older. This Movember is the perfect time to discuss your risk and screening options with your primary care physician or urologist. During this month-long event, men around the country grow mustaches to raise awareness about important topics in mens health like prostate and testicular cancers as well as mental health.
Nearly 1 in every 8 men in the U.S. are affected by prostate cancer. When the disease is found in the beginning stages it is almost always treatable. Most cases that are found early are recognized during routine screenings.
Prostate cancer generally does not cause symptoms in the initial stages. However, men with more advanced disease may experience signs such as:
- Difficulty with urination
- Discomfort in the pelvic area
- Erectile dysfunction
What If My Test Results Are Abnormal
If the results of early detection tests like the PSA test or the digital rectal exam suggest that you might have prostate cancer, your doctor will conduct further testing. The PSA may be repeated, or you may be sent to a specialist for more tests such as a transrectal ultrasound and a prostate biopsy.
In a prostate biopsy, a tissue sample is taken from your prostate. Cancer can only be diagnosed with a tissue sample.
In addition to a PSA test, DRE , and a biopsy, research has yielded additional tests that can detect if cancer is present, and if so, how aggressive that cancer might be:
- The Prostate Health Index combines three blood tests that give a more accurate Phi Score, which gives accurate information based on a high PSA to better determine the probability of finding cancer during a biopsy.
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Cancer Screenings And Prevention
This information will help you and your health care provider decide which cancer screenings you need, when to begin screening and how often you should be screened. Unless otherwise noted, this chart follows screening guidelines of the American Cancer Society and are intended for those persons at average risk.
When Should You Be Screened For Prostate Cancer
Screening guidelines for prostate cancer can be confusing. There is no one rule that applies to everyone. Instead, every patient is evaluated differently based on their risk factors and family history of disease.
It is important to establish a relationship with a primary care physician and talk openly with them about your risk and family history, says Gordon Brown, DO, a urologist at Summit Health. Together, you can develop a plan for screening that makes sense for you.
Certain factors increase the risk of developing prostate cancer. These risk factors will influence when to start screening, explains Dr. Brown, as well as the frequency of screening.
- A family history of prostate or breast cancer
- Race/ethnicity black males are at a much higher risk
We support screening of our male patients after appropriate informed discussions of benefits and risk of screening and proper evaluation of their risk factors, explains Dr. Brown.
As a general guideline The American Cancer Society recommendations the following for PSA screening after a shared decision to screen is made with your doctor.
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Providing Information To The Public To Patients And To Their Families
While awaiting results of current studies, physicians and men are faced with the dilemma of whether to recommend or request a screening test. A qualitative study undertaken on focus groups of men, physician experts, and couples with screened and unscreened men has explored types of information that may help inform a man making a decision regarding prostate-specific antigen screening. At a minimum, men should be informed about the possibility that false-positive or false-negative test results can occur, that it is not known whether regular screening will reduce the number of deaths from prostate cancer, and that among experts, the recommendation to screen is controversial.
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