Screening For Prostate Cancer In Men With A Family History
Burden
The introduction of PSA-based screening for prostate cancer has substantially altered the epidemiologic data for prostate cancer, greatly increasing the number of men with a diagnosis of prostate cancer and thus also the number of men with a father, brother, or son with a history of prostate cancer.
Available Evidence
It is generally accepted that men with a family history of prostate cancer are more likely to develop prostate cancer. A study of twins in Scandinavia estimated that genetic factors may account for up to 42% of prostate cancer risk.18 An analysis from the Finnish site of the ERSPC trial concluded that men with at least 1 first-degree relative with prostate cancer were 30% more likely to be diagnosed with prostate cancer than men without a family history.19 Men with 3 first-degree relatives with prostate cancer or 2 close relatives on the same side of the family with prostate cancer diagnosed before age 55 years may have an inheritable form of prostate cancer associated with genetic changes passed down from one generation to the next. This type of prostate cancer is thought to account for less than 10% of all prostate cancer cases.20
The USPSTF searched for evidence about the potential benefits and harms of PSA-based screening for prostate cancer in men with a family history of prostate cancer.
Potential Benefits
Potential Harms
Advising Men With a Family History of Prostate Cancer
Prostate Specific Antigen Test
A blood test called a prostate specific antigen test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.
As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.
PSA levels also can be affected by
- Certain medical procedures.
Prostate Cancer Screening After Age 70
The decision to continue depends on your general health and life expectancy.Dreamstime/TNS
Q: I just celebrated my 70th birthday and am due for my yearly doctor visit. How does a man decide whether to continue PSA testing for prostate cancer?
A: While some guidelines suggest stopping prostate cancer screening after age 70, the decision to continue depends on your general health and life expectancy.
The reason: Most prostate cancers are low-grade and will not shorten a mans life or diminish his quality of life. On the other hand, diagnosing higher-grade cancer at an earlier stage could lead to treatment to keep the cancer from spreading.
In the past, a man with a high or rising PSA level would have to choose between having an immediate prostate biopsy or living with some uncertainty.
Today, other tests can help predict the presence of cancer, especially cancer that is more likely to spread. Examples include MRI , specific subtypes of PSA blood tests, and urine testing for specific genetic markers.
For men who do opt for prostate cancer screening but may not want immediate treatment even if cancer is likely, the two main strategies are watchful waiting or active surveillance.
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Dr. Behfar Ehdaie, a urologic surgeon specializing in prostate cancer at Memorial Sloan Kettering Cancer Center in New York, said that these varying guidelines are due to the different risk factors that each person faces. Things like family history, environmental factors, race and more can all come into play when it comes to assessing prostate cancer risk.
“There are specific patient level factors that have to go into that decision, including family history, comorbidities, and life expectancy,” said Ehdaie, who said that people who are not expected to live more than another decade may not be advised to get screened. “And of course, the patient’s own preferences are taken into account, their goals, what they want to achieve.”
At What Age Should You Get Screened For Prostate Cancer
The following prostate cancer screening guidelines apply to men expected to live at least ten years.
Men ages 45 to 49 should have a baseline PSA test.
- If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
- If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
- If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test between the ages of 51 and 55.
Men ages 50 to 59 should have their PSA level checked.
- If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
- If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
- If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test at age 60.
Men ages 60 to 70 should have their PSA level checked.
- If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
- If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
- If the PSA level is less than 1 ng / mL, no further screening is recommended.
Men ages 71 to 75 should talk with their doctor about whether to have a PSA test. This decision should be based on past PSA levels and the health of the man.
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Nursing Allied Health And Interprofessional Team Monitoring
One of the major concerns regarding prostate cancer screening is overdiagnosis, which involves overtreatment of low-grade prostate cancer and decreasing the quality of life of the patient by adding treatment-associated side effects and psychological harm when in reality, cancer would not have caused any clinical problems in the patient. This outcome can be overcome by active surveillance . Active surveillance is one of the management strategies in which a super select group of low-grade cancer patients are under close monitoring and followed through their disease course with the expectation to intervene only if cancer progresses. This approach will lead to the avoidance of treatment-associated side effects in such patients. This monitoring is only achievable by cumulative efforts and coordination of care amongst the interdisciplinary team members.
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.
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Cyberknife For Prostate Cancer
If you are diagnosed with prostate cancer, you have treatment options depending on the type and stage of cancer, your age and your health.
Surgery, chemotherapy, other drug therapies and radiation all treat prostate cancer. Sometimes doctors use a combination of treatments. The experts at the CyberKnife Center of Miami are here to help.
CyberKnife Miami is a state-of-the-art cancer treatment center in South Florida that uses non-invasive radiation therapy to treat prostate cancer.
While there are different types of radiation for prostate cancer, our experts believe Stereotactic Body Radiation Therapy or SBRT the type of radiation used by CyberKnife has distinct advantages.
- The cure rate with CyberKnife for prostate cancer is 97-percent.
- Its noninvasive.
- There is no anesthesia or cutting.
- There are no risks of surgery like infection and long periods of downtime.
- CyberKnife treatments can be done infive therapy sessions over 10 days instead of 42 over three months with other types of radiation treatments.
- The CyberKnife radiation beams, which target and destroy the tumor, are exceedingly precise.
- There is less risk of side effects including impotence and incontinence.
If you are diagnosed with prostate cancer, call CyberKnife Miami for a consultation at 305-279-2900 or go to our prostate cancer website now for more information.
We put patients first and that you can count on.
We want to help you get cancer behind you and on with living life to the fullest.
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Rettig said that someone who has a “strong family history” of early onset prostate cancer might want to talk to their primary care provider or other health care practitioner earlier in life, while someone with less risk might prefer to wait.
The guidelines for how often men should be screened again also vary. If you have a high prostate-specific antigen , a protein made by cells in the prostate gland, you may be recommended to come back for more frequent screenings, but those with lower PSA levels might only be advised to come back every four years or so.
“If you’re 55 and have you have a PSA of less than one, you can wait four years to get screened again,” Rettig explained. “Alternatively, if you’re 45 and have a PSA of two and a half, that might be someone who might get a biopsy or be re-screened within the year. … How frequently one would be prescreened is really contingent upon the specifics of the patient.”
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Understanding Your Psa Test Results
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.
When To Stop Prostate Cancer Screenings
Researchers and doctors in favor of screenings say the earlier the prostate cancer is detected, the better the chance of a cure.
Those not in favor of screening say its because prostate cancer generally grows slowly, and the side effects of treatment and some invasive screening tests can be difficult to handle.
But also keep in mind, at least 50% of prostate cancers thought to be slow growing, turn out to be aggressive. The takeaway message is, you cant be too careful.
The United States Preventative Services Task Force or has the following recommendations:
- For men aged 55 to 69, having periodic screenings with the Prostate Specific Antigen Test, a blood test measuring the levels of PSA, a protein made by the prostate, should be an individual decision.
- The USPSTF cautions that for some men, screening can lead to a false positive that can require additional testing, which can lead to complications.
- The USPSTF doesnt recommend screening for those older than 70.
But again, its best to talk to your doctor because there are several screening methods. Some are more invasive than others. There are traditional prostate screenings as well newer screening tools that are less invasive and still provide accurate results.
Here are traditional screenings:
But there are other screening tools that may lead to fewer complications.
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Am I At Risk Of Prostate Cancer
In the UK, about 1 in 8 men will be diagnosed with prostate cancer in their lifetime. We don’t know exactly what causes prostate cancer but there are some things that may mean you are more likely to get it these are called risk factors.
There are three main risk factors for getting prostate cancer, which are things you can’t change. These are:
- getting older it mainly affects men aged 50 or over
If you have any of these risk factors or if you have any symptoms, speak to your GP. They can talk to you about your risk, and about the tests that are used to diagnose prostate cancer. You can also get in touch with our Specialist Nurses, who can help you understand your risk of prostate cancer.
What Should I Expect During A Prostate Exam
As mentioned above, there are two types of screenings that your healthcare provider may use to detect prostate cancer: a PSA blood test and a digital rectal exam . Research shows that the PSA blood test is more effective for detecting prostate cancer. However, the DRE can still find cancer in people with normal PSA levels. For this reason, many healthcare providers recommend both.
Neither test confirms you have prostate cancer, which is why theyre considered screening assessments rather than diagnostic tests.
PSA blood test
For this test, your healthcare provider simply draws a sample of your blood and sends it to a lab for analysis. The PSA blood test measures the amount of prostate-specific antigen in your blood.
There is no official cutoff score that can determine whether or not you have prostate cancer. Instead, the results are used as a gauge to determine if more testing is needed.
If you have a high PSA, you may need further testing such as a prostate biopsy, MRI or other lab tests to determine if prostate cancer may be present.
Digital rectal exam
During a DRE, your healthcare provider inserts a lubricated, gloved finger into your rectum. This way, they can feel your prostate to see if there are any lumps or bumps on the back portion of the gland .
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Screenings Can Lead To High Costs
The cost for a PSA test is fairly lowabout $40.
If your result is abnormal, the costs start adding up. Your doctor will usually refer you to a urologist for a biopsy. Costs may include:
- A consultation fee .
- An ultrasound fee .
- Additional professional fees .
If the biopsy causes problems, there are more costs. You might also have hospital costs.
The Test Is Often Not Needed
Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:
- An enlarged prostate gland.
- Recent sexual activity.
- A recent, long bike ride.
Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.
Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.
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What To Do If You Are Worried About Prostate Cancer
Talk to your GP if you’re worried about prostate cancer. Or if you have urinary symptoms such as difficulty passing urine. The symptoms don’t mean that you have prostate cancer, but it is important to get them checked.
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Adult screening programme Prostate cancerUK National Screening Committee, Last accessed March 20222
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Screening for prostate cancer. External review against programme appraisal criteria for the UK National Screening CommitteeUK National Screening Committee, October 2020
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Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow upC Parker and others
What Is A Prostate Exam
A prostate exam is a screening method used to look for early signs of prostate cancer. In general, a prostate exam includes a PSA blood test and a digital rectal exam .
During the digital rectal exam portion, your healthcare provider carefully inserts their gloved finger into your rectum. This allows them to feel the edges and surface of your prostate gland to detect any potential abnormalities.
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Potential Harms Of Screening And Treatment
Potential Harms of Screening and Diagnosis
In addition to the ERSPC and PLCO trials, the USPSTF examined the results of a good-quality cohort study embedded within the ProtecT trial , a fair-quality cohort study conducted in the US Department of Veterans Affairs health system, as well as a report on complications of prostate biopsy from the ERSPC Rotterdam site to understand the potential harms of screening and diagnosis.3
In the large RCTs, one-fourth to one-third of men offered PSA-based screening had at least 1 positive screening test result. In the PLCO trial, 13% of men had undergone at least 1 biopsy. In the ERSPC trial, nearly 28 biopsies were performed for every 100 men randomized to screening.3 In the ProbE trial, 7.3% of men reported moderate or greater pain, 5.5% reported moderate to severe fever, and 26.6% reported troublesome hematospermia within the 35 days after biopsy.28 Complications from transrectal prostate biopsy resulted in 1.3% of men in the UK cohort, 1.6% of men in the VA cohort, and 0.5% of men in the Rotterdam cohort requiring hospitalization.30-32 In these studies, two-thirds to three-fourths of biopsies demonstrated that the PSA screening test was a false positive.3
Potential Harms of Treatment
In several studies, men older than 70 years had a significantly increased risk of medical complications and perioperative mortality after radical prostatectomy compared with younger men.3