What Research Has Been Done To Study Prostate Cancer Screening
Several randomized clinical trials;of prostate cancer screening have been carried out. One of the largest is the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, which NCI conducted to determine whether certain screening tests can help reduce the numbers of deaths from several common cancers. In the prostate portion of the trial, the PSA test and DRE were evaluated for their ability to decrease a mans chances of dying from prostate cancer.
The PLCO investigators found that men who underwent annual prostate cancer screening had a higher incidence of prostate cancer than men in the control group but the same rate of deaths from the disease . Overall, the results suggest that many men were treated for prostate cancers that would not have been detected in their lifetime without screening. Consequently, these men were exposed unnecessarily to the potential harms of treatment.
A second large trial, the European Randomized Study of Screening for Prostate Cancer , compared prostate cancer deaths in men randomly assigned to PSA-based screening or no screening. As in the PLCO, men in ERSPC who were screened for prostate cancer had a higher incidence of the disease than control men. In contrast to the PLCO, however, men who were screened had a lower rate of death from prostate cancer .
Yes Or No For A Psa Test For Men Over Age 70
We all know that aging is a recognized risk factor for prostate cancer, that it can be cured, but you still need to be screened early to put the odds in your favor. But what about older men? Should men be screened for prostate cancer and have a PSA test past 70 years of age?
The prostate-specific antigen test, or PSA test, makes it possible to detect the disease at an early stage, often in the absence of symptoms, thereby preventing many deaths related to advanced and aggressive cancers. When its level is high, this antigen indicates that there is a problem with the prostate, but it is not necessarily prostate cancer.; Blood levels can go up as a result of various prostate disorders, such as infection, benign enlargement or cancer, or sometimes for no apparent reason.
While this test is currently the best for screening for prostate cancer, it is not perfect. It does not on its own indicate whether it is necessary to treat a patient or how to treat.
It is true that age greatly increases the risk of prostate cancer. However, most prostate tumors, especially in older men, remain small, grow very slowly or not at all, do not spread, and do not cause any symptoms. Many men die with prostate cancer rather than from the disease. In fact, autopsy studies show that three-quarters of men over the age of 75 had prostate cancer – usually small and harmless – and that the vast majority had never known it and had died of something else.
Men 70 and over
When to consult
Healthy People 2030 Target
There is no Healthy People 2030 target related to being screened for prostate cancer. There is a target goal to increase the proportion of men who have discussed the advantages and disadvantages of the PSA test to screen for prostate cancer with their health care provider.
Healthy People 2030 is a set of goals set forth by the Department of Health and Human Services.
Note: Goals are indicated as blue line on Detailed Trend Graphs.
Another Option: Digital Rectal Exams
Most prostate biopsies are driven by PSA results. Urologists also use the digital rectal exam, or DRE.
“The American Urological Association hasn’t recommended rectal exams because there has yet to be a randomized trial in which some men get the rectal exam and some don’t. Based on who lives and dies, this would show if rectal exams have value,” says Dr. Freedland. “Many people, myself included, think they do have value. It’s part of the evaluation that we use even if it’s not officially in our guidelines.”
The DRE may cause momentary discomfort, but it can also detect prostate cancer for those patients with normal PSA levels. “We use the exam because we think it should work and be helpful, even if it hasn’t been studied,” Dr. Freedland adds. “Most people are screened with PSA and DRE.”
How Are Researchers Trying To Improve The Psa Test
Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. None has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include:
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Risk Of Prostate Cancer
About 1 man in 8;will be diagnosed with prostate cancer during his lifetime.
Prostate cancer is more likely to develop in older men and in non-Hispanic Black men. About 6 cases in 10 are diagnosed in men who are 65 or older, and it is rare in men under 40. The average age of men at diagnosis is about 66.
Research Needs And Gaps
There are many areas in need of research to improve screening for and treatment of prostate cancer, including
- Comparing different screening strategies, including different screening intervals, to fully understand the effects on benefits and harms
- Developing, validating, and providing longer-term follow-up of screening and diagnostic techniques, including risk stratification tools, use of baseline PSA level as a risk factor, and use of nonâPSA-based adjunctive tests that can distinguish nonprogressive and slowly progressive cancer from cancer that is likely to become symptomatic and affect quality or length of life, to reduce overdiagnosis and overtreatment
- Screening for and treatment of prostate cancer in African American men, including understanding the potential benefits and harms of different starting ages and screening intervals and the use of active surveillance; given the large disparities in prostate cancer mortality in African American men, this should be a national priority
- How to better inform men with a family history of prostate cancer about the benefits and harms of PSA-based screening for prostate cancer, including the potential differences in outcomes between men with relatives who died of prostate cancer and men with relatives diagnosed with prostate cancer who died of other causes
- How to refine active prostate cancer treatments to minimize harms
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What Is A Digital Rectal Exam
The most common way for doctors to check on the health of your prostate is with a DRE. Its a fairly quick and simple procedure.
For the exam, youll bend at the waist while standing or lie on your side with your knees bent toward your chest.
Your doctor will lubricate a gloved finger and gently place it inside your rectum. Theyll press one hand on your prostate, and their other hand will feel your pelvic area. It should only take a few moments.
You may experience momentary discomfort. You may also feel the urge to urinate, especially if your prostate is enlarged or inflamed.
Your doctor will be able to tell you if your prostate seems to be a normal size and shape. In general, a DRE has no risks.
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Deciding If You Need A Prostate Screening
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Understanding Your Biopsy Results
You might have a negative biopsy. This means that no cancer cells were found. Your doctor might;arrange another biopsy even if the first biopsy was negative. Theyll discuss this with you. This is because in some cases biopsies can miss cancer.;
If they find cancer cells, a pathologist grades each sample of prostate cancer cells from 3;to 5 based on how quickly they are likely to grow or how aggressive;the cells look. You may hear this being called the;Gleason grade, Gleason score or Grade Group.
Gleason score or Grade Group
The pathologist works out an overall Gleason score by adding together the 2 most common Gleason grades.;This combined score is also now called the Grade Group.;
There are 5 Grade Groups. Grade Group 1 is the least aggressive and Grade Group 5 is the most aggressive.;
It can be difficult to understand what the Gleason score and Grade Group mean in your situation. We have more information about the Gleason score and Grade Groups. And you can ask your doctor and specialist nurse if you have any questions about this.;
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Risks Of Prostate Cancer Screening
Screening tests have risks.
The risks of prostate screening include the following:
Finding prostate cancer may not improve health or help a man live longer.
Screening may not improve your health or help you live longer if you have cancer that has already spread to the area outside of the prostate or to other places in your body.
Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. Finding these cancers is called overdiagnosis. It is not known if treatment of these cancers would help you live longer than if no treatment were given, and treatments for cancer, such as surgery and radiation therapy, may have serious side effects.
Some studies of patients with prostate cancer showed these patients had a higher risk of death from cardiovascular disease or suicide. The risk was greatest the first year after diagnosis.
Follow-up tests, such as a biopsy, may be done to diagnose cancer.
If a PSA test is higher than normal, a biopsy of the prostate may be done. Complications from a biopsy of the prostate may include fever, pain, blood in the urine or semen, and urinary tractinfection. Even if a biopsy shows that a patient does not have prostate cancer, he may worry more about developing prostate cancer in the future.
False-negative test results can occur.
False-positive test results can occur.
Your doctor can advise you about your risk for prostate cancer and your need for screening tests.
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This examination lasts “15 to 20 seconds,” according to Ehdaie, and is “uncomfortable” but “not painful.” Rettig noted that on its own, the digital exam is “not going to add very much,” but can be paired with the blood test to give a full picture of the patient’s health situation.
After that exam is completed and the bloodwork is done, the results are “evaluated together.”
“A decision would be made to either pursue further tests because the screenings suggest there may be something that would be of concern, or they would return at the next scheduled ,” Ehdaie said.
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 .
- Biopsy fees .
If the biopsy causes problems, there are more costs. You might also have hospital costs.
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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 a man aged 50 or over and decide to have your PSA levels tested after talking to your GP, they can arrange for it to be carried out free on the NHS.
If results show you have a raised level of PSA, your GP may suggest further tests.
Psa Test For Prostate Cancer
The prostate gland makes a protein called prostate specific antigen . This protein helps to nourish sperm. Normally, only tiny amounts of it enter the bloodstream.
Cancer cells in the prostate interfere with proper functioning and can cause large amounts of PSA to enter the bloodstream. Therefore, when high levels of PSA are detected in the bloodstream, this may indicate cancer.;
Early prostate cancer often has no symptoms. However, high PSA levels can occur five to 10 years before the onset of prostate cancer symptoms. In such circumstances, the PSA test can help to indicate the presence of cancer at an early stage.
Other tests are needed to confirm a diagnosis because an abnormal PSA test can be due to non-cancerous causes. Equally, it is possible for a man to have a normal PSA level when cancer is present.
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Research Suggests Early Prostate Cancer Screening Can Lead To Unnecessary Treatment And Side Effects
A nurse hovers over 46-year-old Allan Martin, instructing him to make a fist, before drawing blood from his left arm.
âItâs about time I got checked again. I havenât had it done for four years,â he told CBC News moments after having blood collected for a prostate-specific antigen test.
Martin, along with dozens of other men, showed up to get their PSA tested at Calgaryâs Prostate Cancer Centre and get a photo with the former professional wrestler Bret Hart just before Valentineâs Day in February.
Hart, a former professional wrestler, became an advocate for early testing after getting diagnosed with prostate cancer in 2015.
âIf you just get your blood work done, it could save your life,â Hart said,;his World Wrestling Federation championship title belt resting on the table beside him. Hartâs older brother, Smith, died in 2017 months after being diagnosed with Stage 4 prostate cancer.
Hart said his brotherâs dying wish was to encourage more men to get PSA; screening early. The annual Bret Hart Menâs Health Day is aimed at getting men to âtake charge of their health.â
The news release announcing the event stressed;that when caught early, prostate cancer is âvery treatable.â
The Canadian Task Force on Preventive Health Care, in fact, recommends against early screening for prostate cancer, saying the âharms of PSA screening outweigh the benefits.â
What Are The Most Common Prostate Problems
For such a little gland, the prostate seems to cause a lot of concern. Like a troubled, war-torn country, itâs in the news all the time and something always seems to be going wrong there, but you donât really know where it is or why itâs important.
All men are at risk for prostate problems. Thatâs because all men have a prostate. Take a look at this overview of prostate problems to assess your risk for trouble with your prostate.
- Age 31-40: one in 12
- Age 51-60: about one in two
- Over age 80: more than eight in 10
However, only about half of men ever have BPH symptoms that need treatment. BPH does not lead to prostate cancer, although both are common in older men.
Prostate Cancer. Prostate cancer is the most common cancer in men . About one man in six will be diagnosed with prostate cancer in their lifetime. Letâs keep these numbers in perspective, though. Because prostate cancer is usually slow growing, only about one in 35 men will die of prostate cancer.
Like BPH, the risk for prostate cancer increases with age. About two out of every three men with prostate cancer are over age 65. No one knows exactly what causes prostate cancer, but risk factors associated with it include:
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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.”
Benefits And Risks Of Screenings
The benefit of any cancer screening test is to find cancer early, when it easier to treat. But the value of PSA screening for prostate cancer is debated. No single answer fits all men.
Prostate cancer often grows very slowly. PSA levels can begin to rise years before a cancer causes any symptoms or problems. It is also very common as men age. In many cases, the cancer will not cause any problems or shorten a man’s life span.
For these reasons, it is not clear if the benefits of routine screenings outweigh the risks or side effects of being treated for prostate cancer once it is found.
There are other factors to think about before having a PSA test:
- Anxiety. Elevated PSA levels does not always mean you have cancer. These results and the need for further testing can cause a lot of fear and anxiety, even if you do not have prostate cancer.
- Side effects from further testing. If your PSA test is higher than normal, you may need to have a one or more biopsies to find out for sure. A biopsy is safe, but can cause problems such as an infection, pain, fever, or blood in the semen or urine.
- Overtreatment. Many prostate cancers will not affect your normal life span. But since it is impossible to know for sure, most people want to get treatment. Cancer treatment can have serious side effects, including problems with erections and urinating. These side effects can cause more problems than the untreated cancer.
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