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What Men Should Know About Prostate Screening

Recommendations recently announced by the U.S. Preventive Services Task Force against using the prostate-specific antigen (PSA)-based screening for prostate cancer has drawn mixed reactions from the medical community.

"The PSA prostate screening is still our most important tool to reduce mortality due to prostate cancer," says Charles Enke, MD, radiation oncologist and prostate cancer specialist at Nebraska Medicine.

Prostate cancer is the number one non-skin cancer in U.S. men and shares the number two spot with colorectal cancer in terms of cancer mortality. Most men ages 70 and older will eventually develop prostate cancer but because some forms of prostate cancer are slow-growing, many will never die from the disease. The Task Force feels that since the majority of deaths due to prostate cancer occur after age 75, the screening has no benefit and that the harms outweigh the benefits.

Dr. Enke feels differently. "We’ve seen a significant decrease in the death rate due to prostate cancer over the last 20 years," says Dr. Enke," and this is due largely to the impact of the PSA screening test that was introduced in 1992. The five-year survival for a person who is diagnosed with prostate cancer today is 99 percent. I’m concerned that these new guidelines will reverse this trend and we’ll start seeing an increase in mortality again."

Dr. Enke recommends that all men ages 50 and older with a life expectancy of at least 10 years discuss with their physician the benefits of getting a PSA screening. "Prostate cancer usually doesn’t produce symptoms until it has become more advanced," says Dr. Enke. "At advanced stages, treatment options are very limited and the odds of mortality are much greater."

Dr. Enke recommends that high-risk individuals, which include African-American males and those men with a first-degree relative who has been diagnosed with prostate cancer at age 65 or younger, be screened starting at age 45.

Chad LaGrange, MD, a urologist at The Nebraska Medical Center, concurs with Dr. Enke.

"PSA screenings have allowed us to diagnose prostate cancer before it has spread," he says. "Once it becomes metastatic, it’s incurable."

Dr. LaGrange believes the bigger problem is in overtreating prostate cancer rather than over-screening. "Physicians need to use better judgment as to whom we treat based on a patient’s risk factors, test results, life expectancy and a frank discussion with the patient," he says. "If it is determined that treatment is not supported, the tumor should be monitored every six months to a year for the patient’s remaining lifetime."

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