Friday, February 3, 2023

Risks Of Prostate Cancer Screening

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Prostate Cancer Is The Most Common Nonskin Cancer Among Men In The United States

Recommendations, benefits and risks of prostate cancer screening Dr. Matthew Tollefson

Prostate cancer is found mainly in older men. In the U.S., about one out of every 8 men will be diagnosed with prostate cancer. Most men diagnosed with this disease do not die from it. Prostate cancer causes more deaths in men than any other cancer except lung cancer. Prostate cancer occurs more often in African American men than in White men. African American men with prostate cancer are more likely to die from the disease than White men with prostate cancer.

Should You Know Your Psa Level

Instead of a national screening programme, there is an informed choice programme, called prostate cancer risk management, for healthy men aged 50 or over who ask their GP about PSA testing. It aims to give men good information on the pros and cons of a PSA test.

If you’re aged 50 or over and decide to have your PSA levels tested after talking to a GP, they can arrange for it to be carried out free on the NHS.

If results show you have a raised level of PSA, the GP may suggest further tests.

Comparison Of Calibrated Models With Malm Results

The calibrated models reasonably replicated the PSA distributions at ages 4450 years and at age 60 years in the Malmö study . The median PSA values in the models were within 0.2ng/mL of the median in Malmo at ages 4450 years and 60 years. The 25-year probability of diagnosis in the absence of screening predicted by the FHCRC model slightly overpredicted the Malmö results, particularly in the upper tail of the PSA distribution at ages 4450 years, where data were sparse. A similar pattern was observed in the comparison of the 15- and 20-year FHCRC predictions with the corresponding Malmö results . The 25-year probability of diagnosis in the absence of screening predicted by the Erasmus-MISCAN model considerably underpredicted the Malmö results, but the 15- and 20-year predictions were much closer to the observed data.

Observed prostate-specific antigen distributions and predicted 25-year risk of diagnosis based on empirical data from the Malmö Preventive Project and corresponding model projections in the absence of screening for men aged 60years. Both empirical and model projections are derived from logistic regression models for event of disease diagnosis over 25years in either the empirical or the modeled data. Erasmus-MISCAN = Erasmus University Medical Center-MIcrosimulation SCreening ANalysis FHCRC = Fred Hutchinson Cancer Research Center.

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Prostate Cancer Screening Ages 40 To 54

The PSA test is a blood test that measures how much of a particular protein is in your blood. Its been the standardfor prostate cancer screening for 30 years.

Your doctor will consider many factors before suggesting when to startprostate cancer screening. But hell probably start by recommending the PSAtest.

While the general guidelines recommend starting at age 55, you may need PSAscreening between the ages of 40 and 54 if you:

  • Have at least one first-degree relative who has had prostate cancer
  • Have at least two extended family members who have had prostate cancer
  • Are African-American, an ethnicity that has a higher risk of developing more aggressive cancers

Harms Of Cancer Screening

Prostate Cancer Screening

All screening tests have potential harms. For more information, visit our Cancer Screening Overview page.

  • Physical harm: Screening tests can cause minor physical harm like bruising or discomfort, as well as serious physical harm like tearing the colon during colon cancer screening.
  • Radiation exposure: Some screening tests use low doses of radiation that can damage healthy cells.
  • False-negative result: Screening tests sometimes miss an instance of cancer, which could lead people to skip going to the doctor when they have symptoms.
  • False-positive result: Screening tests can suggest that cancer is there when it really isnt. A false-positive result can cause anxiety and is usually followed by more tests and procedures, which also have risks.
  • Overdiagnosis: Sometimes screening tests find cancers that are so small and slow-growing that they would never cause any symptoms or become life-threatening. But if people get treatment for these cancers, they are exposed to unnecessary side effects and costs.
  • Psychological harm: Many people feel worried and stressed about getting ready for a screening test, waiting for the results, getting follow-up tests, and getting an inaccurate result.
  • Incidental findings: Cancer screening tests might find an unrelated medical issuesuch as finding an unrelated heart problemand require follow up tests or procedures which also have risks.

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Who Is At Risk For Prostate Cancer

All men are at risk for prostate cancer, but African-American men are more likely to get prostate cancer than other men.

All men are at risk for prostate cancer. Out of every 100 American men, about 13 will get prostate cancer during their lifetime, and about 2 to 3 men will die from prostate cancer.

The most common risk factor is age. The older a man is, the greater the chance of getting prostate cancer.

Some men are at increased risk for prostate cancer. You are at increased risk for getting or dying from prostate cancer if you are African-American or have a family history of prostate cancer.

Statement Of Principal Findings

Based on moderate and low quality evidence, PSA screening seems to increase the detection of prostate cancer of any stage, increases the detection of stage I and II prostate cancer, and slightly decreases the detection of stage III and IV prostate cancer. At the same time, it probably modestly reduces prostate cancer specific mortality but has no effect on overall mortality. While findings from the ERSPC trial reflects a 21% relative risk reduction of prostate cancer-specific mortality , this corresponds to only one less death from prostate cancer per 1000 men screened. Meanwhile, PSA screening is associated with considerable biopsy-related and cancer treatment-related complications. We estimated that, for every 1000 men screened, approximately one, three, and 25 more men will be hospitalised for sepsis, require pads for urinary incontinence, and report erectile dysfunction, respectively.

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Screening Tests For Prostate Cancer

Screening is testing to find cancer in people before they have symptoms. Its not clear, however, if the benefits of prostate cancer screening outweigh the risks for most men. Still, after discussing the pros and cons of screening with their doctors, some men might reasonably choose to be screened.

The screening tests discussed here are used to look for possible signs of prostate cancer. But these tests cant tell for sure if you have cancer. If the result of one of these tests is abnormal, you will probably need a prostate biopsy to know for sure if you have cancer.

Its Tricky Some Get It And Live With It: Uncertainty Of The True Nature Of Prostate Cancer

Genetic Risk Score for Prostate Cancer Screening

A common aphorism about PCa is that you die with it, not from it. This implies that the risk of having PCa is high, but the risk of dying from PCa is low. The patients in our study also referred to PCa as tricky because the level of aggressiveness tends to vary from one case to another. This was explained by Johan, aged 61: Its tricky. Some get it and live with it. They have a harmless version of it, and they dont even know it. Others get a severe diagnosis, and then they just die. They wither away. It goes into the bones and makes them crack. His father was diagnosed with PCa after a fall that broke his back. The course of his disease was short and ugly as Johan put it. His father subsequently died of PCa.

Another patient, Jens, aged 55, also referred to the unpredictable nature of PCa and mentioned a popular Danish politician, Svend Auken, who was diagnosed with PCa in 2004: You know, you die with it, not from it. But there are cases where you die quickly. Svend Auken, for instance. Thats brutal. Other patients also mentioned the Danish TV and cinema documentary Svend, which was released in 2011. The film was originally intended to portray Svend Aukens political endeavours, but it also became a portrait of his fight with PCa that eventually ended his life at the age of 66 in 2009.

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When Is Psa Screening Recommended

The American Cancer Society recommends that men talk to their doctor before having a screening test to check for prostate cancer. That way youâll understand the risks and benefits of testing. Then, you and your doctor can decide whether to go ahead with screenings using a PSA test and digital rectal exam.

When that discussion should take place is based on your age, level of risk, and general health.

Strengths And Weaknesses Of The Study

We conducted this review based on an a priori protocol that defined a rigorous methodological approach based on the Cochrane Handbook and GRADE approach. Patient-centric outcomes and secondary analyses were informed by input from stakeholder representatives from the Rapid Recommendations guideline panel as well as a systematic review of the values and preferences of affected individuals.1213 Our approach included a comprehensive search of multiple databases as well as other sources for relevant publications irrespective of language or publication status. While it is possible that we may have missed some secondary reports of the included trials, it seems unlikely that additional trials were missed.

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Randomized Trials Of Psa Screening

The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

The PLCO Cancer Screening Trial is a multicenter, randomized, two-armed trial designed to evaluate the effect of screening for prostate, lung, colorectal, and ovarian cancers on disease-specific mortality. From 1993 through 2001, 76,693 men at ten U.S. study centers were randomly assigned to receive annual screening or usual care . Men in the screening group were offered annual PSA testing for 6 years and digital rectal exam for 4 years. The subjects and health care providers received the results and decided on the type of follow-up evaluation. Usual care sometimes included screening, as some organizations have recommended.

In the screening group, rates of compliance were 85% for PSA testing and 86% for DRE. Self-reported rates of screening in the control group increased from 40% in the first year to 52% in the sixth year for PSA testing and ranged from 41% to 46% for DRE.

After 7 years of follow-up, with vital status known for 98% of men, the incidence of prostate cancer per 10,000 person-years was 116 in the screening group and 95 in the control group . The incidence of death per 10,000 person-years was 2.0 in the screening group and 1.7 in the control group . The data at 10 years were 67% complete and consistent with these overall findings . Thus, after 7 to 10 years of follow-up, the rate of death from prostate cancer was very low and did not differ significantly between the two study groups.

References

Understanding Your Psa Test Results

The Problem with PSA Screenings, Prostate Cancer and Risk

PSA is usually measured in nanograms per millilitre of blood . There is no one PSA value that is considered normal. The value varies from man to man and increases as you get older. Most men have a PSA level of less than 3ng/ml.

Your GP or specialist may suggest further tests if your PSA level is higher than would be expected for someone of your age. Talk to your doctor about your PSA level and what this means for you.

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American Cancer Society Recommendations For Prostate Cancer Early Detection

The American Cancer Society recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information. The discussion about screening should take place at:

  • Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
  • Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative diagnosed with prostate cancer at an early age .
  • Age 40 for men at even higher risk .

After this discussion, men who want to be screened should get the prostate-specific antigen blood test. The digital rectal exam may also be done as a part of screening.

If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the mans general health preferences and values.

If no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test:

  • Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years.
  • Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.

What Are The Risks Of Prostate Cancer Screening

A couple of the risks to discuss with your doctor are:

Overdiagnosis. This means you get diagnosed with a condition that wouldnât have caused symptoms or problems. Some prostate cancers grow so slowly that theyâd never give you problems during your lifetime. So, you could end up getting tests or treatments that you donât need.

False-positive test result. This is an incorrect result. It says you have a certain health condition when you actually donât. It could lead to follow-up tests that you donât need.

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PC treatments include surgery and radiation therapy, bringing added risks of urinary incontinence and erectile dysfunction. The worry and fear men experience when considering the possible outcomes further fuel the angst of undergoing PC screening.

In the last two decades, the world has seen a sharp uptick in prostate cancer among the young. An increase in screening men under 55 may catch some cases, but many early-onset cases still go undetected.

An Abnormal Psa Test: What Comes Next

Update on prostate cancer screening guidelines

If your PSA score is in the abnormal range, your doctor may recommend yourepeat the PSA test. If your levels are still high, your doctor mightrecommend one of the newer prostate cancer screening tests available today.

These tests can help better assess your risk for prostate cancer anddetermine whether a biopsy is necessary. Only a prostate biopsy candefinitively diagnose prostate cancer.

For individualized recommendations that suit you, ask your doctor about:

  • What age you should start prostate cancer screening
  • New blood, urine and imaging tests that are available
  • Improved biopsy techniques, if applicable

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Prostate Lung Colorectal And Ovarian Cancer Screening Trial

The PLCO trial was designed to determine the effect of annual PSA testing and DRE on mortality from PCa. The screening group was offered annual PSA testing for 6 years and DRE for 4 years. A sextant biopsy was recommended for PSA values 4.0 ng/ml and/or abnormal DRE. The initial power calculation included 37,000 men in each arm and documented a 27% mortality reduction in the screening group versus the control group, with 90% compliance and < 20% contamination . 38,350 men in the control group and 38,343 in the screening group between the ages of 60 and 74 years were enrolled .

The results of the PLCO trial support the validity of the recent recommendation of the USPSTF, especially against screening all men over the age of 75 years . The latest update of the PLCO trial with more person years of follow-up also failed to detect a reduction in mortality from PCa after 13 years. PSA screening was found to be associated with a statistically significant 12% increase in the incidence of PCa and a non-statistically significant decrease in the incidence of highgrade PCa in the screening arm. Correlations with age, baseline comorbidity, or pre-trial testing could not be demonstrated. However, it is important to note that only 57% of study participants were followed to 13 years and included in the update . These results are difficult to interpret based on the flaws of this trial, such as the significantly increasing contamination from PSA testing in the control group.

Screening Information For Prostate Cancer

Screening for prostate cancer is done to find evidence of cancer in otherwise healthy adults. Two tests are commonly used to screen for prostate cancer:

Digital rectal examination

A DRE is a test in which the doctor inserts a gloved, lubricated finger into the rectum and feels the surface of the prostate through the bowel wall for any irregularities.

PSA blood test

There is controversy about using the PSA test to look for prostate cancer in people with no symptoms of the disease. On the one hand, the PSA test is useful for detecting early-stage prostate cancer, especially in those with many risk factors, which helps some get the treatment they need before the cancer grows and spreads. On the other hand, PSA screening may find very-slow-growing prostate cancers that would never threaten someone’s life. As a result, screening for prostate cancer using PSA may lead to treatments that are not needed, which can cause side effects and seriously affect a person’s quality of life.

ASCO recommends that people with no symptoms of prostate cancer and who are expected to live less than 10 years do not receive PSA screening. For those expected to live longer than 10 years, ASCO recommends that they talk with their doctor to find out if the test is appropriate for them.

Other organizations have different recommendations for screening:

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