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Posted on: October 1, 2018

Prostate Health

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With the month of September and Prostate Cancer Awareness Month nearly over, during this month and every month of the year, men wonder if they should be screened for prostate cancer. Before arriving at a decision to be screened or not, it is important that men talk with their doctor about their personal risk for prostate cancer and their options. Men should learn about the possible benefits and harms of screening so that they can make the best choice for them. 

 

Cancer screening 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. However, most prostate cancers grow slowly or not at all.

 

Two tests are commonly used to screen for prostate cancer. Screening begins with a blood test called a prostate specific antigen (PSA) test. This 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 that affect the prostate.

As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others. PSA levels also can be affected by certain medical procedures, certain medications, an enlarged prostate, or a prostate infection. There is also the digital rectal exam (DRE) where 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. Before making a decision, men should talk to their doctor about the benefits and harms of screening for prostate cancer. 

 

Here are some facts from the Centers for Disease Control and Prevention on screening for prostate cancer:

For every 1,000 men between the ages of 55 and 69 years old who are screened, about 1 death will be prevented, and 3 men will be prevented from getting prostate cancer that spreads to other places in the body.

Many men with prostate cancer never experience symptoms and, without screening, would never know they had the disease.

Half of men who die from prostate cancer are 80 years old or older.

 

Here are the possible benefits from screening:

Finding prostate cancers that may be at high risk of spreading, so that they can be treated before they spread. This may lower the chance of death from prostate cancer in some men.

Some men prefer to know if they have prostate cancer.

 

The possible harms of screening for prostate cancer include harms from screening, diagnosis, and treatment. The possible harms of screening for prostate cancer include the following:

  • False positive test results that occurs when a man has an abnormal PSA test but does not have prostate cancer. False positive test results often lead to unnecessary tests, like a biopsy of the prostate. They may cause men to worry about their health. Older men are more likely to have false positive test results. 
  • Screening finds prostate cancer in some men who would never have had symptoms from their cancer in their lifetime. Treatment of men who would not have had symptoms or died from prostate cancer can cause them to have complications from treatment, but not benefit from treatment. This is called overdiagnosis.
  • Prostate cancer is diagnosed with a prostate biopsy. A biopsy is when a small piece of tissue is removed from the prostate and looked at under a microscope to see if there are cancer cells. Older men are more likely to have a complication after a prostate biopsy.
  • A prostate biopsy can cause—
  • Pain.
  • Blood in the semen or ejaculate.
  • Infection.

 

The most common treatments for prostate cancer are surgery to remove the prostate and radiation therapy. The most common harms from prostate cancer treatment are the following:

  • Urinary incontinence (accidental leakage of urine). About 1 out of every 5 men who have surgery to remove the prostate loses bladder control.
  • Erectile dysfunction (impotence). About 2 out of every 3 men who have surgery to remove the prostate become impotent, and about half of men who receive radiation therapy become impotent.
  • Bowel problems, including fecal incontinence (accidental leakage of bowel movements) and urgency (sudden and uncontrollable urge to have a bowel movement). About 1 out of every 6 men who has radiation therapy has bowel problems.


Regarding whether men should be screened for prostate cancer, the Center for Disease Control (CDC) and other federal agencies follow the prostate cancer screening recommendations set forth by the U.S. Preventive Services Task Force (USPSTF), an independent, volunteer panel of national experts in prevention and evidence-based medicine. The USPSTF works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings. 

 

Every screening test has benefits and risks, and the USPSTF states that the risks of PSA testing tend to outweigh the potential benefits. In 2018, the (USPSTF) made the following recommendations about prostate cancer screening:

Men who are 55 to 69 years old should make individual decisions about being screened for prostate cancer with a prostate specific antigen (PSA) test.

Before making a decision, men should talk to their doctor about the benefits and harms of screening for prostate cancer, including the benefits and harms of other tests and treatment.

Men who are 70 years old and older should not be screened for prostate cancer routinely.

 

This recommendation applies to men who—

Are at average risk for prostate cancer.

Are at increased risk for prostate cancer.

Do not have symptoms of prostate cancer.

Have never been diagnosed with prostate cancer.


Here is a video of the U.S. Preventive Services Task Force (USPSTF) recommendations for prostate cancer screening: https://www.youtube.com/watch?v=jw8i43LzdWk

 

The American Cancer Society recommends that beginning at age 50, men who are at average risk of prostate cancer and have a life expectancy of at least 10 years have a conversation with their health care provider about the benefits and limitations of PSA testing. Men should have an opportunity to make an informed decision about whether to be tested based on their personal values and preferences. Men at high risk of developing prostate cancer (black men or those with a close relative diagnosed with prostate cancer before the age of 65) should have this discussion beginning at age 45, and men at even higher risk (those with several close relatives diagnosed at an early age) should have this discussion at age 40.


Prostate cancer is the most frequently diagnosed cancer in American men aside from skin cancer. The only well-established risk factors for prostate cancer are increasing age (the older a man is, the greater his risk for getting prostate cancer), African ancestry, a family history of the disease (a man with a father, brother, or son who has had prostate cancer is two to three times more likely to develop the disease himself), and certain inherited genetic conditions. Men who are concerned that they may have a greater risk for prostate cancer should talk to their doctor about screening.


To help men understand their prostate cancer screening options, they can view this video from the CDC: https://www.youtube.com/watch?v=jm8_OJ9xdIY&feature=youtu.be.

 

To screen or not to screen? Most prostate cancers found by screening are small and slow growing and may not be fatal. Finding and treating prostate cancer before symptoms occur may not improve your health or help you live longer. Some men may have a faster growing prostate cancer and will benefit from early treatment. 

 

To address whether men should be screened or not, it is important for men to learn about prostate cancer and talk to their doctor before they decide to get tested or treated for prostate cancer. If men decide not to get screened, they can always change their mind later. If they decide to get screened, it does not mean they have to go to the next step. They should discuss each step with their doctor.


Attached is a fact sheet to network and please discuss this information with your personal and professional contacts. 

 

For more information on screening for prostate cancer, visit the following websites: The American Cancer Society at www.cancer.org/cancer/prostatecancer/, and/or the Center for Disease Control (CDC) at http://www.cdc.gov/cancer/prostate/index.htm.

 

Even though Prostate Cancer Awareness Month is officially observed in September, it should be observed every month throughout the year.

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