Men: Discuss Prostate Screenings With Your Doctor

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December 2, 2014


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This post is available in: Spanish

It is not surprising that many men in their 40s, 50s, and older are confused about the so-called PSA screening for prostate cancers, since the test is still used but not widely recommended due to the potential for false readings and unnecessary biopsies.

The much-debated PSA (Prostate Specific Antigen) is a blood test for men over 50, (or younger if at higher risk), to help detect prostate cancer. But the PSA is not relied on as a primary indicator, mostly because the test results are considered inaccurate and susceptible to over-diagnosis.

The PSA test actually detects the protein that acts as a biomarker for prostate cancer, but it also detects other things that can lead to higher numbers, effectively creating false alarms that can lead to unnecessary treatments.

In October, Canada’s government task force on preventive health care declined to recommend the PSA as part of a prostate screening program.

The government-backed U.S. Preventive Services Task Force does not recommend PSA screening for prostate cancer. Additionally, the American College of Physicians (ACP) does not recommend it for men younger than age 50 and older than age 69.

The prostate is a gland about the size of a kiwi, located deep in the pelvis, below the bladder. Aside from non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States. More than 200,000 men in the U.S. are diagnosed with prostate cancer annually, says the U.S. Centers for Disease Control and Prevention.

Talk With Your Doctor, U.S. Peer Groups Say
The ACP and the American Cancer Society (ACS) are mostly in agreement about the PSA. The ACS recommends that men with no symptoms of prostate cancer who are in relatively good health should discuss the pros and cons of the PSA with their primary care physician to learn “about the uncertainties, risks, and potential benefits associated with prostate cancer screening.” These talks should generally start at age 50.

As in earlier guidelines, ACS recommends men at high risk — African-American men and men who have a father, brother, or son diagnosed with prostate cancer before age 65 — begin those conversations earlier, at age 45. Men facing an even higher risk — those with multiple family members affected by the disease before age 65 — should start even earlier, at age 40.

“There shouldn’t be any policy because there is no consensus on the PSA,” said Rosendo Collazo, M.D., an internist with the Baptist Health Medical Group at Baptist Hospital. “It’s up to the physician to have that discussion with the patient and let him know that there is a lot of controversy about the PSA.”

PSA Trend May Be Considered
Some physicians may consider a series of PSA readings over time to determine a trend, or whether it is going up, how quickly, and over what period of time, Collazo said. But the test should not be used as the sole barometer for determining risk. In the past, most experts viewed PSA levels less than 4 ng/mL as normal. But much depends on age, family history and other factors that might affect the reading and have nothing to do with prostate cancer.

Digital-rectal Exams Recommended
Men over 50 routinely should undergo a digital-rectal prostate examination as part of a general screening, and it is still considered the most reliable initial test. The physician will feel the prostate for hard, lumpy or abnormal areas.

The digital-rectal test takes only a few minutes to complete. It is advised usually because of a man’s age, or if a problem exists such as difficulty in passing urine. Physical exams are usually combined with a thorough medical history to determine possible symptoms and family history.

“As with everything else, men should be informed about the effectiveness of the physical exam and the questions about the PSA,” said Dr. Collazo. “Be informed as opposed to just saying ‘ok’.”

Signs and Symptoms
Prostate cancer may not cause signs or symptoms in its early stages, but when it is more advanced it may cause signs and symptoms such as:

• Trouble urinating.
• Decreased force in the stream of urine.
• Blood in the urine.
• Blood in the semen.
• General pain in the lower back, hips or thighs.
• Discomfort in the pelvic area.
• Bone pain.
• Erectile dysfunction.

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