Screening for Prostate Cancer
Cancer is a frightening possibility, but today’s medical technology has put some powerful screening tools in our hands, and we know: early detection saves lives. The earlier you find out about cancer, the greater the likelihood that it can be successfully treated. For prostate cancer, 99% of men diagnosed at an early stage (local or regional disease) live 5 years or longer after diagnosis.
So when do you start screening for prostate cancer? Most guidelines recommend that men practice shared decision-making with their physician to make a screening plan, based on evaluation of multiple risk factors. Over time, as researchers have learned more about the factors that affect your chance of getting prostate cancer, recommendations for when to start screening have started to skew earlier. It’s important for you to take the lead in having a candid discussion with your doctor about your risk factors for prostate cancer.
The following questions can help you decide when to begin this conversation with your doctor.
Do you have a family history of prostate, ovarian, breast, colon, pancreas, or other cancers among your male and female relatives? Some families share genetic mutations that make the development of certain cancers more likely. If you know or suspect this is true of your family, begin to discuss screening starting at about 40 years of age. Learn more about genetic factors that affect your risk of developing prostate cancer.
Are you Black? Black men have a greater risk of developing prostate cancer, and of developing aggressive disease, possibly due to as-yet-unknown genetic and socioeconomic factors; unraveling this mystery is an active area of research for the Prostate Cancer Foundation. The National Comprehensive Cancer Network guidelines recommend that you begin joint decision-making with your doctor starting at 40 years of age.
How old are you? The risk of developing prostate cancer in men who do not have other risk factors increases with age. If you don’t have any other risk factors, ask your doctor about screening starting at age 45.
Once you are over about 70 years of age, the US Preventive Services Task Force recommends you stop screening, with the rationale that the potential benefits do not outweigh the harms. Why? Many cases of prostate cancer are very slow-growing, and treatments can be taxing. Statistically, older men are more likely to die of other causes, even when they have prostate cancer. However, if you are a healthy man over 70, the Prostate Cancer Foundation recommends that you continue to discuss screening with your doctor. The decision about whether to screen past age 70 should be made on an individual basis.
The bottom line is that it is never hurts to talk with your doctor about screening. The ultimate goal is to catch active cancer early so it can be successfully treated, to give you the longest, healthiest life possible. Low-risk cancers can be carefully monitored, such that treatment is deferred to only if and when it is needed.
More about genetic factors and their influence on your risk
Genetic testing for inherited cancer risk (sometimes called “germline” genetic testing) can offer powerful insight into your individual risk of developing cancer. Much of the newest research into cancer genetics has focused on identifying inherited changes in genes (mutations) that are associated with development of various types of cancer.
If you have any of the following risk factors, you should discuss them with your doctor and consider genetic testing for inherited cancer risk.
- You are diagnosed with high-risk localized, regional, or metastatic prostate cancer
- A blood relative with a known cancer risk gene mutation, such as a BRCA1/2 mutation or Lynch syndrome
- One relative diagnosed with prostate cancer at age 60 or younger OR with high-risk, regional, or metastatic prostate cancer at any age
- One relative diagnosed with colorectal, endometrial, or breast cancer at age 50 or younger
- One relative diagnosed with male breast cancer, ovarian cancer, pancreas cancer
- Two or more relatives with breast cancer or prostate cancer
- Three or more more family members on the same side of the family, with one or more of the following cancers:
- Endometrial cancer
- Ovarian cancer
- Pancreas cancer
- Colorectal cancer
- Other cancers, e.g., brain cancer
- Ashkenazi Jewish ancestry
If genetic testing reveals that you or a member of your family have one of these critical mutations, your genetic counselor may suggest “cascade” testing. This is when many members of a family are tested to determine who else may have the mutation. With more information at hand, each member of the family can better understand their particular cancer risk, options for early detection, and how to reduce their risk for various other forms of cancer. The information you learn could save the lives of your brothers and sisters, your parents—and your children.