Is Screening Recommended?

Transcript

Screening for prostate cancer is controversial. Like all screenings, ideally the decision to screen for a cancer, meaning to try to detect it early when it’s curable, should be done as part of shared decision-making. That means a careful, thoughtful discussion between you and your provider to decide if the risks and benefits of screening tilt in favor of screening for you.

With prostate cancer it’s a complicated story. Most organizations don’t recommend blanket screening for all men at all ages. In fact, most medical organizations don’t recommend screening under age 40. And on the flip side, don’t recommend screening over age 70. In the age of 40 to 54, most men don’t need screening, but high-risk men do. African-American men need screening at this age, or men who have a strong family history of deadly prostate cancer in first degree relatives in their family. The sweet spot for prostate cancer screening seems to be in the 55 to 69 year old age group.

There is evidence that screening every two years instead of annually might be a good option. Because prostate cancer in a non-threatening form develops so substantially frequently in men in their 70s and 80s, men of advanced age are generally not recommended to undergo screening, because at that age, the harms might outweigh the benefits. Of course, everything needs to be individualized.

More important than chronological age is life expectancy. We can calculate life expectancy based on your medical history and your age, as well as your family history. Generally speaking, PSA screening for prostate cancer is appropriate for men with a life expectancy of 10 years or more.

Key Takeaways

1. Screening for prostate cancer is controversial and should be done after thoughtful discussion between you and your doctor.

2. Most organizations don’t recommend screening for men under age 40 or over age 70.

3. In ages 40 to 54, most men don’t need screening, but high-risk men including African-American men or those who have a strong family history of deadly prostate cancer do.

4. Because it occurs in a non-threatening so often in men in their 70s and 80s, those men, the harms may outweigh the benefits of screening.

5. More important than chronological age is life expectancy, which is based on your medical history, age, and family history.

6. PSA screening for prostate cancer is appropriate for men with a life expectancy of 10 years or more.