Should I get a prostate screening?

If you're an American man, there's a one in 13 chance you could develop prostate cancer at some point during your life. In fact, it's the most common cancer in men after skin cancer.

Unfortunately, prostate cancer typically isn't associated with specific symptoms. Doctors instead rely on screening to identify the disease in at-risk men. Whether to get screened and how beneficial it actually is has been highly debated in the health community.

To screen or not to screen

In 2012, the U.S. Preventive Services Task Force – an independent, volunteer panel of national experts that makes recommendations about clinical preventive services – recommended against screening altogether. The task force stated that the benefit of screening doesn't outweigh the risks, including false-positive results, which could lead to additional, unnecessary testing and prostate biopsy. It should be noted that the urology community was never in support of this recommendation, and expressed significant opposition.

After various more recent studies showed that prostate-specific antigen (PSA) screening could be beneficial for certain age groups, ethnicities and people with a family history, the U.S. Preventive Services Task Force reversed its recommendation.

"Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men," the recommendations state.

The reversal has caused some confusion among physicians and patients.

Benefits of the PSA prostate test

Barrett McCormick, MD, a urologic oncologist at Baptist MD Anderson Cancer Center, said he believes prostate screening is as important as colon and breast cancer screenings.

"Data reasonably supports screening for men 45 to 69 years old and even earlier if you have high-risk factors such as a family history or African American ancestry," Dr. McCormick said. "Ultimately, the decision to screen should be based on an informed decision between the patient and physician, understanding the associated advantages and disadvantages. However, we know that in some men, early screening can identify curable prostate cancers."

Prostate cancer is tested by measuring the amount of prostate-specific antigen (PSA), an enzyme found in the blood. An elevated PSA level could be caused by prostate cancer or another inflammatory process of the prostate gland.

Prostate cancer risk factors and screening guidelines

The newest American Urological Association guidelines include:

• Conduct baseline screening in normal-risk men between ages 45 and 50, earlier for men with risk factors.
• Utilize MRI imaging in at-risk men before consideration of prostate biopsy.
• Offer prostate biopsy in appropriate-risk men after an informed discussion of the risks and benefits of proceeding.
• Some older men may still benefit from screening beyond age 69 depending on overall health and wishes, but this should be an individualized decision between the patient and physician

Long-term studies found PSA-based screening for prostate cancer prevents 1.28 men from dying for every 1,000 men screened, more than previously thought.

Dr. McCormick said the association offers additional recommendations based on a person’s risk factors. Screening can be pursued for men ages 40 to 55 who have:

• A strong family history of prostate cancer
• A history of genetic mutations predisposing themselves or other family members to cancer
• African American ancestry

High chance of being cured

The goal of screening is to find cancer at an early stage before it has caused symptoms.

"Typically, there are no signs of prostate cancer," Dr. McCormick said. "Except when it has become aggressive or has spread throughout the body, signifying the importance of screening."

Overall outcomes for prostate cancer are usually positive since the disease advances slowly. Various treatment options include removal of the prostate gland, radiation therapy or ongoing monitoring for those with low-risk prostate cancer. Cure rates are generally very high but are dependent on the pathologic type of the cancer.

"Very few people die of prostate cancer. Even with the rarer high-grade prostate cancers, there is still a moderate chance for a cure," Dr. McCormick said.