What do men need to know about watchful waiting in order to catch prostate cancer before it becomes aggressive? Dr. Jianan Graybill, radiation oncologist and an MD Anderson Cancer Network® certified physician, explains who should get screened for prostate cancer and outlines current recommendations by age.
Prostate cancer is the most common cancer in America for men behind skin cancer. One in six men will be diagnosed with prostate cancer in his lifetime.
Prostate cancer typically has no symptoms or warning signs in the early stages. For men with advanced disease, these men will typically have urinary symptoms or erectile dysfunction. They may also complain of severe back pain (because the cancer has spread to the spine).
Prostate cancer can often be found early by testing the amount of prostate-specific antigen (PSA) in a man’s blood. Until recently, PSA was routinely obtained from older men as part of their annual physical screening.
However, in May 2012, the U.S. Preventive Service Task Force issued new recommendations.
“The Task Force concludes that many men are harmed as a result of prostate cancer screening and few, if any, benefit. A better test and better treatment options are needed. Until these are available, the USPSTF has recommended against screening for prostate cancer.”
The American Urologic Association responded with this official recommendation to each USPSTF guidelines statement based on scientific evidence.
USPSTF Statement 1: The Panel recommends against PSA screening in men under age 40 years.
AUA Recommendation: In this age group (men under 40 years) there is a low prevalence of clinically detectable prostate cancer, no evidence demonstrating benefit of screening and likely the same harms of screening as in other age groups.
USPSTF Statement 2: The Panel does not recommend routine screening in men between ages 40 to 54 years at average risk.
AUA Recommendation: For men younger than age 55 years at higher risk (e.g., positive family history or African American race), decisions regarding prostate cancer screening should be individualized.
USPSTF Statement 3: For men ages 55 to 69 years the Panel recognizes that the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, the Panel strongly recommends shared decision-making for men age 55 to 69 years that are considering PSA screening, and proceeding based on a man's values and preferences.
AUA Recommendation: The greatest benefit of screening appears to be in men ages 55 to 69 years.
USPSTF Statement 4: To reduce the harms of screening, a routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision-making and decided on screening. As compared to annual screening, it is expected that screening intervals of two years preserve the majority of the benefits and reduce over-diagnosis and false positives.
AUA Recommendation: Additionally, intervals for re-screening can be individualized by a baseline PSA level.
USPSTF Statement 5: The Panel does not recommend routine PSA screening in men age 70 years or any man with less than a 10 to 15 year life expectancy.
AUA Recommendation: Some men age 70 years who are in excellent health may benefit from prostate cancer screening.
The common theme is each man and his physician should decide together if prostate cancer screening is right for him.
Men's health at Community
If you have questions about your risk for prostate cancer, especially if you have a strong family history for prostate cancer or other cancers, call Community Cancer Care to schedule an appointment with an MD Anderson Cancer Network® certified physician at 800-777-7775.