The Importance of Cancer Screening

Although it seems like it should make cancer seem less frightening, cancer screening sometimes can make things seem even more intimidating. Patients often hear different opinions on certain cancer screenings and are often unsure if they are doing all that they can do to detect cancer early.

With prostate cancer, the guidelines and screening protocols seem to be ever-changing. While this means that more knowledge about the disease is being obtained (which is a good thing), it also makes it difficult for patients and even doctors to stay up to date (not so good). This is especially true when it comes to the use of Prostate Specific Antigen, known widely as “PSA.”

PSA is a protein released by the prostate gland into the blood stream. An abnormally high PSA level may indicate prostate cancer. However, it can also be elevated because of non-cancerous causes such as prostatitis or an enlarged prostate. It is also common for PSA to gradually become more elevated as men get older. Therefore, unlike most labs, there is not a clear cut “normal range.” You must include multiple factors such as patient age and other health history to decide if a PSA level is a concern regarding possible prostate cancer.

PSA has been used for prostate cancer screening since 1994. Although widely used, urologists early on were still trying to figure out which patient populations it most benefitted and the ranges where the PSA level should be considered as “high” or “normal.”

Fortunately, with the encouragement of multiple health agencies including the American Urologic Association, the United States Preventive Services Task Force (USPSTF), an independent volunteer group of experts in prevention and evidence-based medicine, reviewed research and realized that PSA screening could be very beneficial in certain demographics. They recommend screening for men ages 55 - 69. They also felt that African American men and men with a family history of prostate cancer are at an increased risk of developing prostate cancer and should discuss the possibility of even earlier PSA screening.

PSA screening is just the beginning. When PSA is elevated you must make the decision of whether you want to do a prostate biopsy. Depending on how aggressive the disease looks under the microscope you may be able to simply keep an eye on it, while on the opposite spectrum you may get results that confirm the cancer is aggressive and may have already spread.

Nothing about prostate cancer is straightforward. Shared decision making is important throughout the entire process. We do feel that from a PSA screening standpoint, all men in their 50s and 60s should be getting annual screening. If you are extremely healthy you may continue screening into your 70s. If you are at higher risk you may consider as early as age 45. The digital rectal exam (DRE) should be utilized as a supplement to PSA screening, especially in equivocal cases looking for nodules.

At the end of the day, we hope to screen the appropriate people and treat the appropriate people to prevent advanced metastatic disease that is lethal. We feel that if patients and doctors stick to the newest recommended guidelines that the number of men dying of advance prostate cancer will decrease significantly. That is why until an even better test comes along, we strongly advocate for appropriate PSA screening.