Reston Hospital Center - August 13, 2018

You might have seen headlines in recent years that metastatic, or late-stage prostate cancer diagnoses have increased by 72 percent over the past decade. But before you panic, let’s take a closer look at the controversy surrounding this statistic and then talk about what you can do to protect yourself.

Studies conducted on research done between 2004 and 2013 alarmingly indicated prostate cancer screenings had declined and the number of metastatic cancers had skyrocketed. The number of late-stage diagnoses is particularly bothersome – unlike localized prostate cancer, metastatic prostate cancer is not curable. Only its symptoms are treatable, and oftentimes patients die from it.

The greatest number of new cases was found among men ages 55 to 69, who experienced a 92 percent uptick in diagnoses. That's deeply troubling as well because this age group is the most likely to benefit from prostate cancer screening and early treatment.

The relationship between screenings and cancer

In 2012, the United States Preventive Services Task Force (USPSTF) recommended against testing men’s blood for prostate-specific antigen (PSA) during routine screenings. PSA is a protein that’s produced by the prostate and tends to be higher among those with prostate cancer. Screenings often include both a PSA blood test and a rectal exam to check for tumors.

By discouraging the PSA test, the task force might have inadvertently played a role in the increasing number of prostate cancer diagnoses. Although, the numbers began rising before the USPSTF made its recommendation.

The question of whether or not to use the PSA test has been debated for a long time in the medical community. The test isn’t always reliable and it’s associated with a number of risks.

However, the American Cancer Society continues to stress that men should learn about the risks and benefits of prostate screenings so they might make an informed decision about whether screening is right for them.  

Risks of prostate cancer screening

The most significant risk of PSA screening is receiving cancer treatment you may not really need. This could happen if your screening comes back with a false positive or if you have a prostate cancer that’s small or slow-growing (because even if left untreated, many prostate cancers never become life-threatening).

However, it’s also possible to receive a false negative, which may cause symptoms to get shrugged off, leading to delayed treatment. 

Benefits of prostate cancer screening

Getting tested for prostate cancer could save your life if it successfully detects early-stage cancer. The earlier cancer is found, the sooner treatment can be started. You should have thoughtful discussions with your doctor before making a decision about screening. 

You should also know that new genetic studies are able to test the urine and blood and can tell us how aggressive the prostate cancer will likely be. There are also active surveillance programs where patients may be closely watched if they have seemingly unaggressive cancer rather than going into a full-blown cancer treatment program.

When to talk to your doctor about prostate cancer screening

Ask your doctor about your risk for prostate cancer and discuss whether a screening is right for you beginning at:

  • Age 40 if you have more than one immediate family member (father, son or brother) who developed prostate cancer before age 65
  • Age 45 if you’re African-American or if you have one immediate family member who was diagnosed with prostate cancer before age 65
  • Age 50 if you’re at an average risk of prostate cancer

While screening suggestions and recommendations are being reviewed, medical experts urge men not to assume their doctors are automatically ordering a PSA test for them. Healthcare insurance might not be covering the screening protocol right now, so you should tell your doctor if you’d like to be tested.

The most important thing you can do is educate yourself about the risks and benefits of prostate cancer screening and then work with your doctor to decide when you should start and how often you should have screenings done.

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