The prostate cancer screening test is the PSA blood test. PSA stands for prostate-specific antigen, a protein produced by the prostate gland that can be detected in the blood. The PSA test is primarily used to screen for prostate cancer. However, PSA levels can also be elevated due to non-cancerous conditions, such as prostatitis (inflammation of the prostate) or benign prostatic hypertrophy (BPH, or prostate enlargement). Therefore, a single elevated PSA blood test might not be indicative of prostate cancer, since prostatitis and BPH are common issues many men face.
Prostate cancer is a cancer that occurs in the prostate, a small walnut-shaped gland in men that produces seminal fluid to nourish and transport sperm. Prostate cancer is the second most common cancer among men worldwide (after skin cancer) and the second leading cause of cancer death in men in the United States.
The Evolution of Prostate Cancer Screening Recommendations
The title of this article, Prostate Cancer Screening: Navigating the Changing Recommendations, refers to changes in guidance from the U.S. Preventive Services Task Force (USPSTF), a leading body that reviews evidence on preventive care and issues recommendations based on recent studies. Initially, in the early 1990s, the USPSTF endorsed the PSA blood test for prostate cancer screening, alongside recommendations for screening other cancers like cervical, breast, colorectal, and lung cancers.
However, in 2012, the USPSTF recommended against PSA screening for all men. This decision was based on studies suggesting that routine PSA screening did not significantly reduce prostate cancer deaths or, at best, showed a modest reduction in mortality. It was also shown that many prostate cancers detected through PSA testing were unlikely to cause harm during a man’s lifetime because many of them were slow-growing and indolent. Furthermore, the studies highlighted significant harms associated with biopsies to diagnose prostate cancer, as well as complications from treatments like surgery and radiation therapy. These harms included incontinence and impotence, often affecting quality of life. For every life saved, many men experienced unnecessary biopsies and treatment-related side effects.
In 2018, the USPSTF updated its recommendations, stating that men aged 55–69 should make an individual decision about PSA screening after discussing the potential benefits and risks with their healthcare provider. This change was based on emerging evidence, including a major study (such as the European Randomized Study of Screening for Prostate Cancer [ERSPC]), which demonstrated that PSA testing could reduce the risk of dying from prostate cancer for some men in this age group. The USPSTF also recognized the importance of personal values in deciding whether to undergo screening, as the benefits (e.g., extended lifespan) must be weighed against the risks (e.g., overdiagnosis and overtreatment).
PSA Testing for Men Over 70
For men aged 70 and above, the USPSTF continues to recommend against routine PSA screening because the potential harms outweigh the benefits. Studies have not shown a clear reduction in prostate cancer deaths for older men, and complications from screening and treatment are more likely in this age group. Additionally, prostate cancer often grows slowly in older men, making it unlikely to cause harm during their lifetime.
What’s Next?
Why does the American Cancer Society recommend starting PSA testing at 50 years old instead of age 55, like the U.S. Preventative Service Task Force?
Can a man request a PSA blood test before age 50?
Can someone 70 years old and older still request PSA testing?
If someone is diagnosed with prostate cancer at any age, how can you avoid being treated too early for a possible slow-growing cancer that may not cause harm during your lifetime? Why is active surveillance and watchful waiting important to understand for answering this particular question?
Why do the American Cancer Society and the American Urologic Society(Urology specialists) recommend a digital rectal exam(DRE) together with PSA blood testing?
I will explore these issues further in Part 2 of Prostate Screening: Navigating the Changing Recommendations. Stay tuned for advice on navigating diagnosis and treatment decisions, as well as understanding active surveillance and watchful waiting.
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