It’s easy to see why men are confused with so much conflicting information about the right way to screen, diagnose and treat prostate cancer. While prostate cancer is the most common cancer in men, it is often overdiagnosed and overtreated.
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To help patients make sense of prostate cancer diagnosis and treatment, here are some recommendations:
1. Begin with PSA screening — a prostate-specific antigen (PSA) blood test and digital rectal exam
Have a discussion with an informed professional about the pros and cons of PSA screening. Consider seeing a urologist to do this, as one recent study found that many primary care physicians do not even mention PSA to their at-risk patients. While many professional organizations have questioned the value of regular PSA screening, all have recommended that patients make an informed choice about the issue.I believe that a screening regimen should be done in an individualized way, based on each man’s results and risk factors.
As a baseline, I recommend that men get their first PSA screening in their 40s so the urologist can recommend the right screening protocol. A low PSA result, for example, indicates a low lifetime risk of developing prostate cancer, so repeat PSA measurements won’t need to be done as often. Data also shows that a PSA < 2 when a man reaches 60 means there is a miniscule chance of dying of prostate cancer, and this suggests that screening is no longer needed for these individuals.
Men with other risk factors should be screened more often, such as a man with a first-degree relative with prostate cancer, which doubles your risk of being diagnosed with prostate cancer.
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2. Take advantage of the new tools that can help prevent overdiagnosis and overtreatment
In the past, men whose PSA was at a worrisome level (either a high absolute value or a rise over time) would automatically be referred for a biopsy.
In my practice, I conduct a second test for these men called PCA3, a marker that is more specific than PSA for prostate cancer and is measured in urine after a DRE. This helps to further define the risk that cancer is present and greatly reduces the number of men who are subjected to a biopsy.
New genomic testing is also helping to make a more accurate diagnosis and treatment plan for prostate cancer. These tests can determine how aggressive a tumor is, another factor that both doctors and patients can use in determining whether treatment or expectant management is best.
3. Talk to your doctor about an individualized approach
Remember that most prostate cancers are asymptomatic, confined to the prostate and easily cured. If your PSA on screening is high, talk to your physician about how tools like PCA3 can reduce the likelihood of a potential false-positive result, and if you are diagnosed with cancer, genomic testing that can determine the tumor’s aggressiveness.
It’s time to refine the way that we screen men for prostate cancer. Taking a more personalized approach to screening can go a long way toward addressing the overdiagnosis and overtreatment of prostate cancer.