Experts say continued prostate cancer screening is an individual choice even as risk increases with age.
An estimated one in eight men in the United States will be diagnosed with prostate cancer during their lifetime. Other than skin cancer, prostate cancer is the most common cancer in men.
Although it’s possible for men to develop prostate cancer at any age, “the older we get, the higher the likelihood is that we have prostate cancer,” says Amir Lebastchi, MD, a urologic oncologist with USC Urology, part of Keck Medicine of USC. Dr. Lebastchi specializes in diagnosing and treating prostate cancer and is an assistant professor of clinical urology at the Keck School of Medicine of USC.
The national prostate cancer screening guidelines recommend against screening for prostate cancer after the age of 69, despite the increased risk of prostate cancer that comes with age. But as Dr. Lebastchi emphasizes, deciding to continue screening is “an individual decision for each patient.”
What does prostate cancer screening involve?
Prostate cancer screening begins with taking a detailed history. “It is important to understand if there is a family history of prostate cancer — especially in the patient’s father or brothers,” Dr. Lebastchi says. “I also ask about other associated malignancies in the family, including breast, colon or ovarian cancers.”
These details are important because although there is no definitive answer as to what causes prostate cancer, a man’s lifetime risk increases if a close relative had the disease. “Many experts think there is a genetic component,” Dr. Lebastchi adds. The risk of prostate cancer is also higher in Black men.
Prostate cancer screening includes a prostate-specific antigen (PSA) blood test. PSA is a protein produced by the prostate. This test measures how much PSA the prostate is generating and secreting into the bloodstream. Elevated PSA levels can be an indicator of cancer. The second part of physical screening is a digital rectal exam.
When to start prostate cancer screening?
The American Cancer Society recommends that men at average risk for prostate cancer have a conversation with their doctor about screening starting at age 50.
Men at higher risk of prostate cancer, including Black men and those with a first-degree relative who was diagnosed with prostate cancer, should ask about screening starting at age 45.
Men with at least two first-degree relatives with prostate cancer should consider screening beginning at age 40, especially if their father or brother was diagnosed with the disease when they were younger than 65.
Finally, Dr. Lebastchi recommends that men with baseline PSA levels above 2.5 ng/mL get screened annually. “But if the baseline PSA was low, then patients can recheck PSA less frequently,” he adds. Every two years is the typical recommendation for lower-risk patients, he says.
At what age should men stop regular prostate cancer screenings?
The U.S. Preventive Services Task Force says men should be screened for prostate cancer until age 69. The American Cancer Society recommends screening for prostate cancer only if the patient expects to live at least 10 more years.
The primary reason for this is that prostate cancer tends to grow slowly, and the average life expectancy for men in the U.S. is 75. “The data suggests most men with prostate cancer die with the cancer, not from it,” Dr. Lebastchi explains. That is why some men don’t get screened once they hit age 70, he says.
That said, Dr. Lebastchi strongly emphasizes that the only way to determine whether someone’s prostate cancer is a slow-growing type is to continue regular screenings with additional workup if necessary. “A patient with a high PSA and a family history of prostate cancer is more likely to have an aggressive, fast-growing cancer,” he says.
He also stresses that the decision to stop or continue prostate cancer screenings is patient specific. “In my clinic, I practice personalized medicine. People are living longer these days due to advances in medicine. If patients come to me in their 70s and 80s with good life expectancy and want to continue screening, I’m happy to do it,” he says.
What should patients know about prostate cancer treatments?
If a patient exhibits rising PSA levels, the next steps include a prostate MRI and a needle biopsy to get an accurate diagnosis. Depending on the severity, specialists may recommend active surveillance to monitor the cancer’s growth.
“We’d check PSA levels every six months and perform repeat biopsies every one or two years depending on the baseline biopsy result,” Dr. Lebastchi explains.
For more aggressive cancers, he says the “gold standard treatment options” involve radiation or surgery to remove the prostate. “However, when patients get screened, we may have a chance to detect prostate cancer in the early stages, when even less-invasive treatment options — such as ‘focal therapy options’ — may be feasible in select patients.”
What are the signs of prostate cancer?
Prostate cancer is the second-leading cause of cancer deaths among men in the United States. However, regular prostate cancer screenings are saving lives. The Prostate Cancer Foundation says that when prostate cancer is diagnosed early, the five-year prostate cancer survival rate is about 99%.
There are no warning signs during the early stages of prostate cancer. Screening is the only way to find prostate cancer early.
Patients with advanced prostate cancer can have symptoms such as trouble urinating, blood in the semen or unexplained weight loss, especially once the cancer has grown or spread to other areas of the body like the lymph nodes or the bones.
As Dr. Lebastchi says, national prostate cancer screening guidelines are only a starting point. “We need to make screening and treatment decisions on an individual basis,” he concludes.
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