Cancer | Men's Health
June 26, 2018

Men: What to ask your doctor about prostate cancer screening

by doctor talking with man about screening

Making sense of the updated guidelines for prostate cancer screening.

 

In 2012, the United States Preventive Services Task Force recommended that men of all ages should not be routinely screened for levels of prostate-specific antigen (PSA). These are the blood tests to detect the possibility of prostate cancer.

That group now recommends that men ages 55 to 69 should talk with their doctors and make well-informed individual decisions about the potential harms and benefits of PSA screening, and treatment if cancer is found.

The practical takeaway is that there is no longer a do or don’t for routine screening starting at age 55. Men need to understand the potential tradeoffs of screening or not screening and talk with their doctors before making a shared decision.

Why the change?

The task force considered two important factors in the change. “The first was new information about the number of cases of metastatic disease avoided by screening,” said David Penson, M.D., MPH, the chair of the Department of Urologic Surgery at Vanderbilt University Medical Center.  “They found that for every 100 men screened, three cases of metastatic disease would be avoided.”

“Second, they noted a greatly increased used of active surveillance in men with low risk disease,” Penson said. “This reduced the harm of over-diagnosis and overtreatment and changed the balance.”

Questions to ask yourself and your doctor about screening

Do you want to know if you have even the slightest risk of death from prostate cancer?

An advantage of PSA screening is earlier prostate cancer detection. While prostate cancer is the second most common cancer in American men, most of the men who are diagnosed will not die from the disease.

Are you more tolerant of the uncertainty that may follow the news of an elevated PSA level? 

Screening isn’t perfect. Sometimes it misses cancer, and sometimes it finds something suspicious that turns out to be harmless.

Am I at greater risk for getting prostate cancer?

Risk factors include:

  • Being African American;
  • Having a father, brother or son who had prostate cancer;
  • Age, because the older you are, the greater your risk.

What is a normal PSA Level?

There is no specific PSA level that points to the possibility of cancer. Most doctors consider anything over 4.0 ng/mL, or 4 nanograms per milliliter of blood, as above the typical range.

You may want to ask for a second test if you have had prostatitis or a urinary tract infection. These conditions may elevate PSA levels. In general, a higher PSA level points to a greater likelihood of prostate cancer and rising levels over time are also a warning sign.

Screening

Vanderbilt Urology Clinic offers the latest information, expert diagnosis and treatment for urologic diseases and conditions, including cancers of the prostate and sexual health problems. Connect with our experts at 615-322-2880.

9 thoughts on “Men: What to ask your doctor about prostate cancer screening”

  1. Paris says:

    Estimated at about 30 percent of men aged above 50 years suffering from prostate cancer unconsciously. In fact, the number is increased up to 90 percent in men aged about 90 year. That is way, men are encouraged to always do a routine health check every year. This activity should start before the age of 40.

    1. Terry L Hoffman says:

      What does a routine health check for a male consist of?

    2. Maura Ammenheuser says:

      Terry, it depends on age. This post has a good checklist of what men should get checked: http://www.mysouthernhealth.com

  2. Deb Pearl says:

    Thank you for all the questions you should ask your doctor about a screening. My husband needs to go in for an appointment, but he doesn’t know what to ask. I think it is a great idea to ask if his PSA level is normal, or if he needs a second test.

  3. Larry says:

    They all try to sell you on biopsy.

    1. Maura Ammenheuser says:

      Larry, if one doctor’s recommendation doesn’t sit well with you, we encourage you to get a second opinion. As this article points out, there’s a lot of factors to consider — including the ramifications of skipping a biopsy, and of getting one. We hope this helps you sort through the advice you’re getting.

  4. Jim Cook says:

    I had my first psa screening when I was 52. My psa was 24.20. My urologist did a second psa check. By then it was 26. I’m still here at 66 years old. That psa screening saved my life. I’m one of the 3%. I see the concern about so many biopsies. So deal with that. If these guidelines had been in effect in 2004 I’d have died years ago.

  5. Thomas Westgren says:

    It’s interesting how you said that older men should talk to their doctor to ensure that they are making a good choice about getting a prostate cancer screening. I’m not getting any younger and my wife and I are getting worried that I might end up with something like cancer. We’ll have to look into getting a good doctor who could help us get a good screening so we know if I need a prostate cancer surgery or something like that.

    1. Maura Ammenheuser says:

      Thomas, you’re smart to get the conversation started. Prostate cancer is not necessarily something to panic about, but as this post points out, there are pros and cons to the screening, so figuring out what makes the most sense for you personally is something that your doctor can help you with. Good luck!

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