When it comes to early detection of prostate cancer, informed, shared decision making is essential so people understand the benefits and risks of screening.
Kelvin A. Moses, MD, PhD, FACS
Associate Professor of Urology, Vanderbilt University Medical Center
Preston Sprenkle, MD
Associate Professor of Urology, Yale University School of Medicine
Health decisions work best when they are made as a partnership between patient and physician. Doctors follow the science and understand the latest research and expert recommendations. Patients are their own best advocates and can communicate their comfort level with known and unknown risks of screening and treatment. This is why guidelines are conversation starters to help find the best fit for each individual. When it comes to early detection of prostate cancer, informed shared decision-making is essential so people understand both the benefits and the risks of screening.
The term “prostate cancer” refers to a spectrum of changes within the prostate that range from non-aggressive, slow-growing disease that may not require treatment, to aggressive, fast-growing disease in which treatment is usually warranted. It’s considered over-treatment to treat most slower-growing tumors (as treatment in such cases may cause side effects without affecting cancer outcomes), but it is very important to find fast-growing tumors early so that patients can get potentially life-saving medical care. In the United States, males have a one-in-eight chance of eventually being diagnosed with prostate cancer, and a 1-in-41 chance of dying from it. Fortunately, death rates have fallen by 52% from 1993-2018, largely thanks to early detection and improved treatment.
However, prostate cancer deaths did increase recently from 26,730 in 2017 to 31,620 in 2019, possibly due in part to declining screening rates. There are also growing concerns about people delaying recommended screening as a result of the COVID-19 pandemic who are now being diagnosed with more advanced cancer, making it harder to treat. Cancer organizations across the country have been sharing the important message: Cancer Won’t Wait and Neither Should You.
Prostate cancer early detection programs, using prostate-specific antigen (PSA) testing for healthy people, can discover both slower- and faster-growing disease. Thankfully, researchers have developed techniques designed to reduce unnecessary biopsies and over-diagnosis, particularly for patients with mildly elevated PSA levels. Those methods include imaging of the prostate with multiparametric MRI (mpMRI), an MRI-targeted biopsy (as opposed to a standard biopsy), biomarker testing using urine or blood, and/or continued PSA testing combined with digital rectal exams.
PSA testing for healthy, informed individuals is currently recommended at age 45-75 for average risk people and age 40-75 for those in higher-risk groups. Those higher-risk groups include:
- People with inherited genetic mutations (e.g. BRCA2)
- Family history of cancer (especially metastatic prostate cancer, breast cancer diagnosed by age 45, and ovarian cancer)
- Black/African-American men
Black men have a higher incidence of prostate cancer, increased prostate cancer mortality, and earlier age of diagnosis. There are data showing that the highest contribution to prostate cancer treatment and mortality disparity is due to lower rates of screening and treatment for Black men. Genetic contribution is a very small percentage of the increased risk.
Additionally, it’s important that anyone with a prostate, regardless of their gender identity, have PSA screening discussions with their doctor.
Healthcare is personal. Screening for prostate cancer can be life-saving, however, it can also lead to unnecessary anxiety, distress, or intervention-related side effects. Communication between patients and healthcare providers is key to make sure the right persons receive the appropriate screening to safeguard their health.