Prostate Cancer Screening?

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Prostate cancer has gained increased media attention and search activity due to its high incidence and prevalence rates. Prostate cancer is the second most common cause of cancer in men, and the second leading cause of cancer-related deaths in men. This results in over 30,000 deaths per year in the United States. Prostate cancer is a disease strongly associated with advanced aging.  The decision to screen for prostate cancer and the subsequent treatment plan chosen can be difficult as about 1 out of every 6 men will be diagnosed with prostate cancer in their lifetime, but only 1 in 30 will die of the disease.

In addition to aging, other risk factors include genetics, race, and dietary habits.  Patients are 2.5x more likely to develop prostate cancer if they have an affected first-degree relative and 5x more likely if they have 2 or more affected first-degree relatives.  African-American males have a higher incidence of prostate cancer, typically present at a more advanced stage, and have a higher mortality.  Consumption of excess dietary fats and red meat may increase risk.

As noted above, there are concerns related to overdiagnosis, which can have negative impacts on patients, both physically and mentally. This has made the decision of when to implement screening difficult, and complicated decisions regarding treatment of diagnosed prostate cancer. In order to limit overdiagnosis and guide treatment, risks are considered along a continuum of clinical states.  If the patient does not have cancer, several factors are considered before screening which include: life expectancy and probability that a cancer is present.  For patients with prostate cancer, the model considers how likely the patient is to develop symptoms or experience mortality related to the disease. The model also guides treatment based on disease severity.

The decision to screen for prostate cancer should be made with each individual and their care provider. Screening is performed via digital-rectal examination (DRE) and/or prostate-specific antigen testing.  About ¼ of men with an abnormal DRE have prostate cancer. Guidelines regarding PSA screenings differ based on organization.  A full discussion of PSA screening is outside the scope of this post. Please visit the supplemental readings for a complete discussion on PSA screening. Here are the current prostate cancer screening guidelines from ACS, ACP, USPSTF, EAU, and NCCN.

CURRENT Practice Guidelines in Primary Care 2019: Chapter 6: Genitourinary Disorders: Prostate Cancer Screening

Harrison's Principles of Internal Medicine, 20e: Chapter 83: Benign and Malignant Diseases of the Prostate

The MD Anderson Manual of Medical Oncology, 3e: Chapter 37: Prostate Cancer

Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education