The importance of all health screenings is that they can detect issues early. Prostate cancer is one of the most common cancers in the world, and the second-leading cause of cancer deaths among men in the U.S.
While many prostate cancers grow slowly and remain localized, other types are aggressive and spread quickly. Screening can find prostate cancer early, when it’s still confined to the prostate gland. That’s when patients have the best chance for successful treatment. If caught early (stage 1), the survival rate after five years is almost 100%. At stage 4, the survival rate is 37% to 50% at the five-year mark.
It’s recommended that men begin talking about prostate cancer screening with a health care professional around age 50. During this discussion, the clinician will decide if the prostate-specific antigen test is right for an individual, based on personal risk level and age, as well as the chance of overdiagnosis or underdiagnosis, possible biopsy complications, and testing intervals.
The screening is relatively simple. The most common is a prostate-specific antigen, or PSA, test. It’s conducted by a primary care clinician once a year. The PSA test is a blood test used to measure the amount of prostate-specific antigen in the blood.
High levels may indicate the presence of cancer. However, other conditions may also increase this level.
Screening intervals are personalized. Based on test results, men with low long-term risk may decide to discontinue testing or lengthen the time between tests. Those with higher PSA levels may require more frequent screening.
Who’s at risk?
Risk factors include age, family history and race.
Age: The risk for prostate cancer is highest beginning at age 50 or older.
Family history: If a blood relative who has or has had prostate cancer, a family history of genes such as BRCA1 or BRCA2 that increase the risk of breast cancer, or a strong family history of breast cancer, risk may be higher.
Race: In the U.S., prostate cancer is deadlier for Black men than for men of other races. They’re more likely to get prostate cancer and more than twice as likely to die from it than other men. Black men should consider being screened starting at age 40.
Active surveillance
Not all prostate cancers need to be treated—some can remain under active surveillance. When prostate cancer is found early, it can be watched for many years. If it becomes aggressive, treatment can begin. In active surveillance, regular follow-up tests may be performed to monitor the progression of the cancer.
Treatment options
Along with active surveillance, a full range of treatments for prostate cancer is available, including radiation, hormone therapy, chemotherapy, cryosurgery and surgery, including robotic removal of all or part of the prostate.
Many patients who have just a few sites of metastatic disease, meaning that the cancer isn’t widely spread, can also benefit from aggressive treatment. This treatment combines radiation and oral or IV cancer medication therapy to put the cancer into remission and extend the patient’s life.
Another radiation technique includes intensity-modulated proton beam therapy with pencil beam scanning. This localized treatment can minimize significant adverse events from the treatment.
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