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Screening Secrets: What Every Man Should Know About Prostate Cancer Screening

Prostate cancer is the most common type of non-skin related cancer in men, and it is the second leading cause of cancer-related deaths in men within the United States, behind lung cancer.  Fortunately, if caught early, prostate cancer remains highly treatable and curable with minimally invasive procedures. 

“What does screening look like?”

Screening tools for prostate cancer have seen significant advances during the last two decades.  Historically, we relied on prostate specific antigen (PSA) testing and digital rectal exams to determine if a biopsy was needed. These remain critical components of screening for prostate cancer, but when used alone can lead to unnecessary biopsies. In recent years, we have seen development of critical adjuncts to prostate cancer screening, including prostate MRI imaging and urine/blood-based biomarker tests, which look for genetic material and proteins that signify an increased risk of prostate cancer.  These tools have allowed us to recommend prostate biopsy only when clinical suspicion for prostate cancer is high. This has significantly reduced the number of unnecessary prostate biopsies. And fortunately, Colorado Mountain Medical and Vail Health have invested heavily in making all these tools available for our patients.

“When should I get screened for prostate cancer?”

Men over the age of 45 should be considered for prostate cancer screening. Screening consists of an annual PSA blood test and prostate exam every 1 to 2 years.  Additional testing may be recommended based on these results. 

“Who is most at risk of prostate cancer?”

African American men and men with family history of prostate cancer are at increased risk and should start screening in their early 40s.  Men with a strong family history of breast and ovarian cancer in female relatives may also be at increased risk and should speak to their doctor about screening after 40.  Typically, we recommend discontinuing screening after the age of 75, but this is dependent on patients’ overall health and life expectancy, and some men will continue screening much later than this.  

“How do I schedule a screening? Is it covered by insurance?”

Prostate cancer screening can be conducted during your normal annual wellness exam and is covered by insurance.  Alternatively, you can schedule a consultation with a urologist for the necessary testing.  

“I thought PSA screening was no longer recommended?”

I get this question often. I believe it originates from a previous, shocking recommendation by the U.S. Preventive Services Task Force (USPSTF), a government-supported agency. In 2012, the USPSTF surprised the medical community by recommending against prostate cancer screening on the grounds that potential harms of over-treatment can outweigh the benefits of screening. This was largely based on a U.S.-based clinical trial called the Prostate, Lung, Colorectal, and Ovarian cancer (PLCO) trial, which found no reduction in prostate cancer deaths in patients screened during a 17-year period.  Unfortunately, this trial was severely biased in that almost 90% of the men who were in the “unscreened” group of this trial had PSA testing at some point throughout the years the trial was conducted.  Strong advocacy from organizations such as the American Urological Association (AUA) and the Society of Urologic Oncology (SUO), citing a much cleaner European trial that clearly showed the benefits of screening, led the USPSTF to realize the fault in their recommendations against screening.  And, in 2018 the USPSTF reversed course and recommended screening again for patients after shared decision-making with their physician. Unfortunately, because of these years of anti-screening recommendations, we saw a significant shift of men present with metastatic prostate cancer, a non-curable condition.  Today, there are still some lingering misconceptions that prostate cancer screening is unnecessary or harmful.  Urologists continue to advocate for prostate cancer screening through individualized shared decision-making conversations with their patients.

“What lifestyle changes I can make to help reduce my risk of prostate cancer?”

To reduce your risk of prostate cancer, I suggest:
•    Eat a heart-heatlhy diet.
•    Avoid tobacco and excessive alcohol intake.
•    Maintain an active lifestyle.
•    Schedule routine medical checkups and screenings.
•    Limit exposue to environmental toxins.

Knowledge is one of the best tools for protecting your health. If you have questions about prostate cancer, or if it’s time for your next screening, please schedule an appointment with your primary care provider or a urologist. Early detection saves lives — and starting the conversation is the first step.