Screening Guidelines for Prostate Cancer

Prostate cancer is the second most common cancer in American men.  While the disease is prevalent across the country, the screening guidelines are not.  Prostate cancer screenings have always been somewhat controversial because the tests often alert physicians to the presence of cancer, but there is no precise way to determine, definitively, whether the cancer detected would have ever caused symptoms or harm during the man’s lifetime.

The benefit of screening for prostate cancer is identifying high-risk, localized prostate cancer that can be successfully treated, thereby preventing the morbidity and mortality associated with advanced or metastatic prostate cancer.  The potential harms of screening for prostate cancer may be false-positive results (often in older men) that lead to unnecessary biopsies and harms from prostate cancer treatment that might include erectile dysfunction, urinary incontinence, and bowel problems.

The American Cancer Society (ACS) recommends that men have a chance to make an informed decision with their healthcare provider about whether to be screened for prostate cancer.  The discussion about screening should take place at:

– Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.

– Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).

– Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

After this discussion, men who want to be screened should get the prostate-specific antigen (PSA) blood test.  The digital rectal exam (DRE) may also be done as a part of screening.

If no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test:

– Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years.

– Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.

While it is true that not all prostate cancers need treatment, early detection is still one of the most important factors to surviving cancer.  If your family medical history, lifestyle, or other factors indicate that you are at greater risk for prostate cancer, make sure you discuss prostate cancer screenings with your physician and decide if a screening is right for you.