An article that published on May 8 on Philly.com titled, “Is Prostate Cancer Screening Right for You? Let’s Do the Numbers” caught my eye with its mention of new recommendations. Those of us in health care who care for men on a daily basis are pleased with the updated recommendation that recognizes that PSA-based screenings can be a benefit for some men in the early detection of prostate cancer.
In 2012, the influential U.S. Preventive Services Task Force (USPSTF) recommended against prostate cancer screening in all men. But in the May 8 publication in JAMA, this group updated that recommendation. It is now recognized that for healthy men age 55-69, PSA-based screening may offer a chance to reduce death from prostate cancer. The group still does not endorse screening for any man over the age of 70, however.
Prostate cancer is the most common solid tumor in U.S. men and the second leading cause of cancer death, but there are risks as well as benefits to screening, particularly with the PSA blood test. The new recommendation addresses both sides.
The world of prostate cancer care has moved to much smarter screening and treatment approaches for the disease. For example, newer tests, other than PSA blood testing, may identify those men who may harbor life-threatening cancer and those that may have so called “autopsy” or non-aggressive cancer that will never harm them in their lifetime. Advances in genetics and genomics are also answering what a man’s lifetime risk of developing prostate cancer may be and the likelihood of dying of the disease.
The task force appropriately notes that there can be side effects of treating early prostate cancer with surgery or radiation. However, there have been improvements in treatments and the increased use of active surveillance, a way of following men with prostate cancer that avoids aggressive treatment in many men.
The death rate from prostate cancer has decreased dramatically over the last 20 years. Much of this decline has been attributed to improvements in treatments and the PSA-based detection of early aggressive prostate cancer before it spreads outside the prostate gland and becomes incurable. Each man should have a discussion with their provider that considers age, family history, overall health and other factors to decide if being screened for prostate cancer is right for them.
Leonard Gomella, MD, FACS, is the Bernard W. Godwin professor of prostate cancer in the Sidney Kimmel Medical College at Thomas Jefferson University, chairman of the department of urology at Thomas Jefferson University Hospital, and senior director of clinical affairs at the NCI-designated Sidney Kimmel Cancer Center.