Should I Be Screened for Prostate Cancer?

September is National Prostate Cancer Awareness Month.  Prostate cancer is the most common cancer in American men, and it accounts for the second highest number of deaths from cancer in men.  According to the CDC, 31,636 men died of prostate cancer in the United States in 2019.

You might be wondering if you should be screened for prostate cancer.  There are differing opinions on who should be screened, how often, and at what age, but most organizations support a patient-centered approach in which men discuss the pros and cons of prostate cancer screening before engaging in a screening program.

Prostate cancer screening is primarily performed using a PSA (prostate-specific antigen) blood test.  PSA is a marker for both prostate cells and prostate cancer.  If this blood test is elevated for your age group, then it could represent possible prostate cancer and would require further workup to confirm if prostate cancer is actually present.

Over the past several years, there has been some controversy regarding prostate cancer screening recommendations.  The primary issue is that prostate cancer severity can range from a relatively benign disease to a very aggressive disease.  As a result, many men will live with prostate cancer that never spreads, and they will eventually pass because of some other condition or disease.  On the other hand, prostate cancer will spread in some men and could shorten their lifespan.  Because some disease is not aggressive, there is concern that these men may be over-treated.  There is also concern that PSA testing may lead to further workup, such as a biopsy, which can cause pain or side effects.  In addition, the knowledge of having a cancer, even if it is not aggressive, can be disturbing to some patients.  While these are arguments in favor of potentially foregoing prostate cancer screening, on the flip side, some men will die from prostate cancer, and identifying them and treating them may lead to improved survival and quality of life.

Another question might be at what age a man should begin screening for prostate cancer if he would like to have prostate cancer screening.  Again, there are several different recommendations, but there is an age range at which prostate cancer screening is most effective.  The USPSTF (United States Preventative Services Task Force) recommends men from the age of 55-69 to discuss screening with their physician.  The NCCN (National Comprehensive Cancer Network) recommends screening for ages 45-75 for average-risk patients.  It remains unclear what the ideal age to begin prostate screening is and the age to discontinue testing.  NCCN experts were unable to agree on an age to discontinue screening, but they do agree that men with a life expectancy of fewer than 10 years should not undergo screening.

The previous discussion has focused on men who are at average risk for prostate cancer.  There are groups of men who are thought to have a higher risk of prostate cancer or potentially more aggressive disease.  Men with a family history of prostate cancer (first-degree relative: father, son, or brother) and men of African ancestry have a higher risk of more aggressive prostate cancer.  A smaller group of men may have a heritable genetic mutation in their family, which may lead to a higher risk of prostate cancer.  Men in these groups are recommended to undergo initial screening at age 40 rather than 45 per the NCCN.

While there remains significant discussion regarding how best to approach prostate cancer screening for men, there is evidence that prostate cancer screening may reduce prostate cancer-related death by identifying the disease in the earlier stages at which time it can be treated curatively.  Men who wish to undergo prostate cancer screening should also understand that a less aggressive cancer may be identified, which may not need to undergo immediate curative treatment.  If you wish to proceed with prostate cancer screening or you have further questions about it, I recommend that you discuss your particular situation with your primary care physician to see if prostate cancer screening is right for you.