June is Men’s Health Month, dedicated to raising awareness about health care for men and encouraging boys, men and their families to practice and implement healthy living decisions. As men begin to age, they may begin to wonder about the appropriate time to begin screening for certain health conditions, including prostate cancer.
“Over time, there have been changing recommendations whether or not to screen for prostate cancer,” explained Dr. Chelsey McNabb-Pender, an outpatient internal medicine physician at ThedaCare-Encircle Health. “Scientific data has not yet clearly proven that the benefit of screening outweighs the potential harms.”
Although the benefits of getting screened seem straightforward, maybe you’d detect a cancer earlier, leading to a better outcome, there are some potential downsides.
“Screening may lead to false positive results that lead to unnecessary biopsies, when a patient did not actually have cancer,” Dr. McNabb-Pender said. “There is also risk of over-diagnosis or over-treatment.”
In some cases, prostate cancer can be slow-growing and may not lead to death or cause bothersome symptoms, she said. In other cases, the cancer can be aggressive. The American Cancer Society (ACS) notes that for American men, prostate cancer is the second leading cause of death, behind lung cancer, killing about one man in 41. However, the five-year survival rate when the disease is caught early is very high.
Professional medical societies such as the ACS, the American College of Physicians, the American Urological Association and the U.S. Preventive Services Task Force now agree that the best approach to starting screening is a shared decision between a physician and their patient. Those discussions normally should begin for men between the ages of 50 to 55.
African-American men and Caribbean men of African descent should discuss with their providers whether to begin screening earlier as the disease occurs more often in this population, and often at a younger age. While about one in eight white men will develop prostate cancer in their lifetimes, one in seven African-American men will develop the disease and are more than twice as likely to die from it.
Additionally, any men who have had a close relative with a prostate cancer diagnosis should inform their medical provider.
“If a man has a strong family history of prostate cancer diagnosed at younger than 65 years old, earlier screening may be considered,” Dr. McNabb-Pender said. “Other factors, such as a patient’s health status, will also to take into account.”
Screening is not recommended for men whose life expectancy is less than ten years, for example.
According to the ACS, risks for developing prostate cancer can include:
•Age. Six in 10 cases of prostate cancer are found in men over the age of 65.
•Race. More cases occur in African-American and Caribbean men of African descent.
•Geography. North American men are among those at greater risk.
•Family history. Most prostate cancers occur in men without a family history of the disease, but a diagnosis in a close family relative — a father or a brother — more than doubles a man’s risk.
•Inherited gene mutations. The BRCA1 and BRCA2 gene mutations that are associated with an increased risk of breast and ovarian cancer are also associated with prostate cancer. Men with Lynch syndrome have an increased risk of certain cancers including prostate cancer.
•Chemical exposures. Some evidence shows a link between firefighting chemicals and prostate cancer, and there may be a link with Agent Orange exposure as well.
The main way providers will screen for prostate cancer is through a blood test called a prostate-specific antigen, or PSA, screening. Historically, a digital rectal exam (DRE) as a part of the physical exam has been used to screen for prostate cancer. Many professional societies no longer recommend this routinely, only if the PSA level is elevated, Dr. McNabb-Pender said.
“Deciding when to screen for prostate cancer is an important discussion to have with your provider at your annual wellness visit,” she said. “By discussing things together, you can make the best choices for screening going forward.”
