Should you get screened for prostate cancer?

Q: Should I get screened for prostate cancer?  My friends and I are around the same age, and some of them have had a PSA test and others haven't.  Is there a general recommendation I should follow?

A: Prostate specific antigen or PSA testing remains the main screening test for prostate cancer, along with clinical prostate gland examination by a clinician.  PSA is produced by the prostate gland in men and is measured in blood.  Although PSA can increase from other causes than prostate cancer, higher levels of PSA may indicate the presence of prostate cancer.

While PSA testing has been successful at identifying cancers at an early stage (when cancer is more treatable), studies also indicate that over-diagnosis and over-treatment of prostate cancer could be a concern when it comes to prostate cancer screening.  This is because men often die with and not because of prostate cancer.

Some prostate cancers are slow growing, and although PSA testing might find early stage disease, cancer treatments and their related side effects might be unnecessary for older men with slow growing cancer. On the other hand, for some men, diagnosing prostate cancer early and undergoing treatment can make a difference in their outcome, and screening may save their lives.

Since we can't yet determine which early stage prostate cancers can progress to advanced disease and which can be left untreated, a number of professional organizations, including the American Cancer Society and the American Urological Association, recommend that patients and physicians decide together whether a patient should undergo PSA testing.

Known as informed or "shared decision-making," this process occurs when patients, with the guidance of their clinician, become attuned to their risk for prostate cancer, their preferences for screening, and the potential risks, benefits and uncertainties of prostate cancer screening – all before undergoing testing.  Shared decision-making takes place at an earlier age for men considered to have an increased risk for prostate cancer.

More specifically, it is generally recommended that African American men and men with a family history of prostate cancer engage in conversations with their clinicians about PSA testing around ages 40-50, compared to age 50-55 for men at average risk.  For average-risk men who decide to undergo PSA testing and have a normal result, testing is generally recommended every two years.  Those with an abnormal result will follow-up with their physicians and may need to be screened more frequently.

The guidelines for prostate cancer are constantly being evaluated as new scientific evidence emerges.  It is important for men to keep current with screening guidelines and talk to their clinicians about their personal risk for prostate cancer. For more information on prostate cancer screening, the National Cancer Institute and American Cancer Society serve as reliable resources.

Shannon M. Lynch is an Assistant Professor in the Cancer Prevention and Control Program at Fox Chase Cancer Center.

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