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What Age To Screen For Prostate Cancer

Estimate Of Magnitude Of Net Benefit

Prostate health: Prostate screening, cancer and treatments

Conclusions from decision analysis models, which are consistent with the findings of randomized trials and cohort studies, suggest that more aggressive screening strategies, particularly those that use a lower PSA threshold for biopsy than generally used in the United States, provide the greatest potential reduction in death from prostate cancer. However, these strategies are also associated with more false positives, more biopsies, and higher rates of overdiagnosis.24

Options for reducing the overdiagnosis rate include lowering the age at which to stop screening, extending the interval between screenings, and using higher PSA thresholds for biopsy. However, no strategy completely eliminates overdiagnosis. PSA-based screening for prostate cancer every 2 or 4 years instead of annually appears to provide a good trade-off between a reduction in overdiagnosis and a small reduction in mortality benefit.24

Although active surveillance may reduce exposure to the potential harms of active treatment, it may not be viewed favorably by some men who value definitive action, are concerned about repeat biopsies, or want to avoid a potential increase in metastatic cancer.

There Are Risks To Getting Prostate Cancer Tests And Treatments

If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.

Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.

Research Suggests Early Prostate Cancer Screening Can Lead To Unnecessary Treatment And Side Effects

A nurse hovers over 46-year-old Allan Martin, instructing him to make a fist, before drawing blood from his left arm.

âItâs about time I got checked again. I havenât had it done for four years,â he told CBC News moments after having blood collected for a prostate-specific antigen test.

Martin, along with dozens of other men, showed up to get their PSA tested at Calgaryâs Prostate Cancer Centre and get a photo with the former professional wrestler Bret Hart just before Valentineâs Day in February.

Hart, a former professional wrestler, became an advocate for early testing after getting diagnosed with prostate cancer in 2015.

âIf you just get your blood work done, it could save your life,â Hart said, his World Wrestling Federation championship title belt resting on the table beside him. Hartâs older brother, Smith, died in 2017 months after being diagnosed with Stage 4 prostate cancer.

Hart said his brotherâs dying wish was to encourage more men to get PSA screening early. The annual Bret Hart Menâs Health Day is aimed at getting men to âtake charge of their health.â

The news release announcing the event stressed that when caught early, prostate cancer is âvery treatable.â

The Canadian Task Force on Preventive Health Care, in fact, recommends against early screening for prostate cancer, saying the âharms of PSA screening outweigh the benefits.â

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Finding Prostate Cancer Early

There is no national screening program for the early detection of prostate cancer. Doctors have different opinions about whether all men without symptoms of prostate cancer should be tested.

There is concern that testing healthy men will cause unnecessary harm and lead to treatments that may not offer long-term benefits. Treatment for prostate cancer can leave men with side effects such as erectile dysfunction and continence issues, which can affect their quality of life.

Testing may identify fast-growing or aggressive cancers that have the potential to spread to other parts of the body and would benefit from treatment. It may also detect very slow-growing cancers that are unlikely to be harmful.

Weigh up all the risks and benefits before deciding whether to be tested for prostate cancer, particularly if you dont have symptoms. Talking to your doctor can help.

Digital Rectal Examination And Psa

PSA Screening

Prostate biopsy prompted by abnormal findings on digital rectal exam , such as nodularity or induration of the prostate leads to a diagnosis of prostate cancer in only 15%-25% of cases. This compares with prostate cancer prevalence of less than 5% among men of similar age without abnormal DRE. Although neither accurate nor sensitive for prostate cancer detection, abnormal DRE is associated with a 5-fold increased risk of cancer present at time of screening.

PSA Screening has revolutionized prostate cancer screening. PSA is a serine protease produced by the prostatic epithelium and secreted in the seminal fluid in large quantities. Prostatic disease changes the cellular barriers that normally keep PSA within the ductal system of the prostate and thereby alters serum levels. The level of PSA in serum is increased by inflammation of the prostate, urinary retention, prostatic infection, benign prostatic hyperplasia, prostate cancer, and prostatic manipulation.

Like DRE, PSA is, therefore, neither accurate nor optimally sensitive for prostate cancer screening only 15%-25% of cases with PSA greater than 4.0 ng/dL are found to have prostate cancer on biopsy.

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Men: Cancer Screening Exams By Age

These exams are for men at average risk of cancer.

Take this checklist to your next doctors appointment. Your doctor can help you develop a more tailored screening plan if needed.

These exams are for men at average risk of cancer. If you believe you may be more likely to develop cancer because of your personal or family medical history, visit our screening guidelines page to learn about exams for men at increased risk.

Ages 40-49

  • Beginning at age 40, you should speak with your doctor about the benefits and limitations of prostate screening.
  • If you choose prostate cancer screening, you should get a digital rectal exam and PSA test every year starting at age 45 to check for prostate cancer if you are African American or have a family history of prostate cancer.

Ages 50-75

Age 76 and older

If youre age 76 to 85, your doctor can help you decide if you should continue screening. MD Anderson does not recommend cancer screening for men age 85 and older.

All Ages

Speak with you doctor about cancer screening exams for lung and skin cancers. Exams are available for those at increased risk.

Regardless of your age, practice awareness. This means you should be familiar with your body so youll notice changes and report them to your doctor without delay.

Risks Of Prostate Cancer Screening

Screening tests have risks.

The risks of prostate screening include the following:

Finding prostate cancer may not improve health or help a man live longer.

Screening may not improve your health or help you live longer if you have cancer that has already spread to the area outside of the prostate or to other places in your body.

Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. Finding these cancers is called overdiagnosis. It is not known if treatment of these cancers would help you live longer than if no treatment were given, and treatments for cancer, such as surgery and radiation therapy, may have serious side effects.

Some studies of patients with prostate cancer showed these patients had a higher risk of death from cardiovascular disease or suicide. The risk was greatest the first year after diagnosis.

Follow-up tests, such as a biopsy, may be done to diagnose cancer.

If a PSA test is higher than normal, a biopsy of the prostate may be done. Complications from a biopsy of the prostate may include fever, pain, blood in the urine or semen, and urinary tractinfection. Even if a biopsy shows that a patient does not have prostate cancer, he may worry more about developing prostate cancer in the future.

False-negative test results can occur.

False-positive test results can occur.

Your doctor can advise you about your risk for prostate cancer and your need for screening tests.

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What Is Screening For Prostate Cancer

Some men get a PSA test to screen for prostate cancer. Talk to your doctor, learn what is involved, and decide if a PSA test is right for you.

Cancer screeningexternal icon means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.

If you are thinking about being screened, learn about the possible benefits and harms of screening, diagnosis, and treatment, and talk to your doctor about your personal risk factors.

There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.

What Is A Prostate Cancer Screening Like

When To Screen For Prostate Cancer

A prostate cancer screening can be conducted in one of two ways. The first, a PSA test, is a simple blood draw. The second is a brief rectal exam that takes less than 30 seconds to perform.

“For a screening, if a patient comes and asks for a prostate cancer screening, it begins with a blood test,” said Ehdaie. “It’s a small vial of blood, and then a medical history and physical examination. In the physical examination there will be a digital rectal examination in which the physician’s finger is inserted into the rectum to feel the prostate.”

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Potential Harms Of Screening And Treatment

Potential Harms of Screening and Diagnosis

In addition to the ERSPC and PLCO trials, the USPSTF examined the results of a good-quality cohort study embedded within the ProtecT trial , a fair-quality cohort study conducted in the US Department of Veterans Affairs health system, as well as a report on complications of prostate biopsy from the ERSPC Rotterdam site to understand the potential harms of screening and diagnosis.3

In the large RCTs, one-fourth to one-third of men offered PSA-based screening had at least 1 positive screening test result. In the PLCO trial, 13% of men had undergone at least 1 biopsy. In the ERSPC trial, nearly 28 biopsies were performed for every 100 men randomized to screening.3 In the ProbE trial, 7.3% of men reported moderate or greater pain, 5.5% reported moderate to severe fever, and 26.6% reported troublesome hematospermia within the 35 days after biopsy.28 Complications from transrectal prostate biopsy resulted in 1.3% of men in the UK cohort, 1.6% of men in the VA cohort, and 0.5% of men in the Rotterdam cohort requiring hospitalization.30-32 In these studies, two-thirds to three-fourths of biopsies demonstrated that the PSA screening test was a false positive.3

Potential Harms of Treatment

In several studies, men older than 70 years had a significantly increased risk of medical complications and perioperative mortality after radical prostatectomy compared with younger men.3

Research Into Prostate Cancer Screening

Many prostate cancers grow very slowly and dont cause men any problems in their lifetime. Overall, evidence from trials of prostate screening has shown that prostate cancer screening does not reduce the number of men dying from prostate cancer.

The Cancer Research UK CAP trial looked at whether a single PSA blood test would reduce the number of men dying of prostate cancer. This was a large UK study with over 400,000 men between the ages of 50 and 69 taking part. Around half the men were offered a PSA blood test the other half weren’t.

The results in early 2018 showed that the number of men dying from prostate cancer was the same in both groups. This was after 10 years of follow up. The researchers say that this trial doesnt support PSA testing as a screening test for prostate cancer. They say we need more research to find a better screening test.

This supports what the 2013 Cochrane review found. This looked at screening research from a number of trials and concluded that prostate cancer screening did not reduce the number of men dying from prostate cancer.

Research looking at doing more than one test doesnt show that this would help either. Increasing the number of tests could increase the level of harms such as diagnosing those cancers that wouldnt cause any harm . Many men have side effects from treatment and the risks of routine PSA screening outweigh the benefits.

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At What Age Should You Get Screened For Prostate Cancer

The following prostate cancer screening guidelines apply to men expected to live at least ten years.

Men ages 45 to 49 should have a baseline PSA test.

  • If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
  • If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
  • If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test between the ages of 51 and 55.

Men ages 50 to 59 should have their PSA level checked.

  • If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
  • If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
  • If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test at age 60.

Men ages 60 to 70 should have their PSA level checked.

  • If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
  • If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
  • If the PSA level is less than 1 ng / mL, no further screening is recommended.

Men ages 71 to 75 should talk with their doctor about whether to have a PSA test. This decision should be based on past PSA levels and the health of the man.

Who Should Get A Digital Rectal Exam

Prostate Cancer Early Detection Guidelines for Floridians ...

Not all medical institutions agree on when men should begin screening for prostate cancer or even if a DRE should be part of the screening.

To help detect prostate cancer in its early stages, the American Cancer Society recommends that men talk to their doctors about the benefits, risks, and limitations of prostate cancer screening before deciding whether to be tested.

For most men at average risk, discussions about screening begin at age 50. However, some doctors recommend that men at higher risk of prostate cancer — African-American men or men with a family history of prostate cancer — start screening earlier.

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Summary Of Recommendations And Evidence

For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy overdiagnosis and overtreatment and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening . C recommendation.

Screening for Prostate Cancer: Clinical Summary of the USPSTF Recommendations

Population

Note: For a summary of the evidence systematically reviewed in making this recommendation, the full recommendation statement, and supporting documents, go to .

Population

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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