With more than 2,200 new cases of prostate cancer expected to occur in Kentucky this year and nearly 400 deaths, it’s worth taking note of new screening guidelines by an expert panel.
The U.S. Preventive Services Task Force recently issued a recommendation that men between the ages of 55 and 69 chat with their physicians about the potential benefits and harms of prostate cancer screening and make an individual decision on whether to get tested.
The panel’s advice represents a shift from 2012, when it recommended against routine use of PSA (prostate-specific antigen) testing, saying it has little lifesaving benefit and carries significant risks, such as the possibility of false positives and treatment downsides, such as erectile dysfunction.
The new recommendation “means you’re going to provide the service basically to certain patients, depending on individual circumstances,” said Dr. Joseph Flynn, chief administrative officer of the Norton Medical Group and physician in chief of the Norton Cancer Institute. “I don’t consider it an oh-my-gosh-stop-the-presses change.”
However, he said, it does bring to mind the need to be a strong advocate for your health. “Especially with prostate cancer screening,” Flynn said, “you should take the time to read what are the risks of being screened … and what are your risks of harm from some of the secondary evaluations.”
It’s also good to know whether you’re at increased risk of prostate cancer because of your race or family history, so the task force included a special section to help those men and their clinicians make decisions about screening.
“African-American men are more likely to develop prostate cancer than white men,” the task force notes in a Q&A. “They’re also more than twice as likely as white men to die of prostate cancer. This is due in part to African-American men having higher rates of more aggressive cancer and the fact that African-American men tend to be diagnosed when their cancer is more advanced.”
The PSA test checks to see whether a man has an elevated PSA level, which could be the result of prostate cancer or another condition, such as having an enlarged prostate or inflammation of the prostate.
“Research suggests that 20 to 50 percent of men diagnosed with prostate cancer after screening may be overdiagnosed,” which refers to being diagnosed with cancer that wouldn’t affect the man’s health during his lifetime, the Q&A notes. “The discovery of an overdiagnosed cancer can result in overtreatment, including invasive procedures, chemotherapy, and radiation, which can have significant harms.”
But there’s new evidence that screening men in the 55-to-69 age group can reduce the risk of metastatic cancer — the type that’s spread to other areas of the body — and reduce the chance of dying from prostate cancer, the task force notes.
Still, “the net benefit is small,” Flynn said, so the task force’s advice isn’t “an overwhelming recommendation to get screened.”
The panel took note of the fact that there’s been increased use of “active surveillance,” which is an alternative to rushing every patient into invasive treatment.
Active surveillance is a type of cancer monitoring that includes regular repeated PSA testing as well as often repeated digital rectal examination and biopsy of the prostate.
This monitoring “has become a more common treatment choice for men with localized, low-grade prostate cancer over the past several years and may reduce the potential harms of screening in low-risk men who choose this option,” the Q&A notes.
The American Urological Association issued a statement supporting the task force’s recommendation for the 55-to-69 age group but said it doesn’t think all men who are above that age should be ruled out for screening. The task force recommends against screening those who are age 70 and up.
“While we agree that a number of older men are not candidates for prostate cancer testing, we believe that select older, healthier men may garner a benefit,” the association said. “We urge those men to talk with their doctors about whether prostate cancer testing is right for them.”
Flynn said men should be alert to signs or symptoms, such as pain or having to get up a lot at night to urinate “If you’re having symptoms, you should be seen.”