Should I get screened for prostate cancer?
Unlike routine mammograms for breast cancer or colonoscopies for colorectal cancer, screening for prostate cancer is a nuanced decision that should be made through a thoughtful conversation between a patient and their health care provider. This process, called shared decision-making, helps ensure that screening is tailored to each individual’s health, risk factors and personal values.
Prostate cancer is one of the most common types of cancer in men, second only to skin cancer. The prostate, part of the male reproductive system, is located below the bladder and surrounds the opening of the bladder. Most prostate cancers grow slowly, and most people with the condition die of another cause: The five-year survival rate for prostate cancer is nearly 100%.
What is shared decision-making?
Shared decision-making is a collaborative process where health care providers and patients work together to make informed health care decisions. For prostate cancer, the patient and provider will collaboratively discuss and weigh the benefits and risks of screening. This means considering a patient’s:
- Age: Risk for prostate cancer increases with age, but screening usually isn’t recommended for men over age 70.
- Family history: Having a close relative (parent, child or sibling) with a history of prostate cancer significantly raises a man’s risk of developing the condition.
- Race/ethnicity: Black men are at higher risk of prostate cancer than other groups.
- Overall health status: Also known as “performance status,” this is how well a patient would tolerate treatment if screening is positive.
- Other medical conditions: Someone with other serious medical conditions, such as another cancer or heart disease, may choose to focus on treating those conditions rather than be tested for prostate cancer.
- Life expectancy: Screening may be discouraged in patients with a less than 10-year life expectancy.
For example, a healthy 50-year-old with a strong family history* of prostate cancer may benefit from screening, while a 70-year-old with end-stage heart disease might face more harm than good from the process.
When to start the conversation
Men at average risk of prostate cancer should begin talking to their health care provider about prostate cancer screening at age 50. If you are Black or have a strong family history, screening may be considered as early as age 40-45.
Screening is typically done every one to two years.
Guidelines recommend stopping prostate cancer screening around age 70, but patients are encouraged to talk to their doctor about whether continuing screening beyond age 70 is appropriate for them. A doctor may recommend additional screening based on an individual’s risk factors.
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What should patients know before talking to their doctor
If you’re considering prostate cancer screening, you may want to start with a conversation with your primary care doctor, or urologist if you have one. When you talk to your health care provider, be up to date on:
- Your family history of prostate cancer
- Your current health conditions
- Your smoking history
What prostate cancer screening looks like
The primary screening tool for prostate cancer is a PSA (prostate-specific antigen) blood test. Sometimes, a digital rectal exam (DRE) is also performed. While the PSA test is simple, interpreting the results isn’t always straightforward. PSA levels can be elevated for reasons unrelated to cancer, such as:
- Urinary tract infection
- Certain medications such as testosterone
- Benign Prostatic Hyperplasia (BPH), which is common with age
- Prostatitis
- Prostate manipulation (i.e., catheter use, ejaculation, recent cycling)
These false positives can lead to unnecessary anxiety and further testing, including a prostate biopsy, which carries risks like infection and bleeding.
Pros and cons of screening
Benefits:
- Early detection of aggressive or high-risk cancers, leading to better outcomes
- Potential to reduce serious complications or death
Drawbacks:
- False positives that may lead to unnecessary procedures
- Overdiagnosis prostate cancer that may never cause harm
- Emotional stress from uncertain or misleading results
Not all prostate cancers require treatment. Many are slow-growing and may be monitored; this is called active surveillance. The benefit of delaying treatment, or not treating, low-risk prostate cancers is avoidance of treatment complications such as incontinence or erectile dysfunction.
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Prostate cancer screening isn’t a simple yes-or-no decision. It’s a conversation, one that should start with your health care provider. The goal is to make an informed choice that aligns with your health status and personal preferences.
*A strong family history of prostate cancer is if more than one close relative (parent, child or sibling) has had prostate cancer.
Chirag Patel, M.D., is a board-certified urologist with the Mid-Atlantic Permanente Medical Group. He sees patients at the Kaiser Permanente Lutherville-Timonium Medical Center.