Men: Discuss Prostate Health with Your Doctor

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Recent updates by the American Cancer Society and the National Comprehensive Cancer Network recommend that men discuss with their doctors their personal need for prostate cancer screening, based on a complete medical and family history.

The American Cancer Society has released its revised screening guidelines for the early detection of prostate cancer. The last set of guidelines was issued in 2001 and modified in 2008. The new revision is based on early findings from 2 large studies which evaluate whether standard prostate screening exams, including the prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE), saves lives.

The first study, carried out by US researchers, randomly assigned more than 76,600 men to two groups. One group received usual care which includes baseline screening at age 50, and annual screening thereafter. The second group had annual PSA tests for 6 years and DRE every year for four years. There were little difference in prostate cancer mortality (death rates) between the two groups, even after 10 years of follow-up.

The second trial known as the European Randomized Study of Screening for Prostate Cancer or ERSPC evaluated 182,000 men from 7 different countries. Men in the intervention group had PSA tests every four years and a DRE twice over the same period. The control group used the current guidelines for screening. After 9 years, the annual screenings reduced the rate of prostate cancer death by 20%, but researchers said that 48 men would have to be treated to prevent one death.

Unlike some other forms of cancer, prostate cancer can either grow very slowly and never cause problems while others are more aggressive, according to the American Cancer Society. Early prostate cancer screening cannot tell the difference and at times can lead to false positive results. Diagnostic tests, such as biopsy, and treatments for prostate cancer can have unpleasant side effects, such as incontinence and impotence.

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Dr. James L. Mohler, guidelines panel chair from the National Comprehensive Cancer Network (NCCN) explains the rationale: “The panel believes….that there are many men diagnosed with low-risk prostate cancer for whom the survival benefit of treatment is low and may be lower than the risk to quality of life from treatment side effects.”

Because of these complex issues, the American Cancer Society recommends that doctors involve the patients in the decision of whether to get screened for prostate cancer and have devised a set of decision-making tools to help patients make an informed choice.

Men with no symptoms who are in relatively good health and can expect to live at least 10 more years should begin discussing screening options with their physicians at age 50. Men at high-risk for prostate cancer, including African-American men and those who have had an immediate family member diagnosed with prostate cancer before age 65, should begin to discuss screening with their doctors at age 40 to 45. Men in poor health who are not expected to live more than 10 years should not be offered prostate cancer screening, as risks likely outweigh the benefits.

The ACS also recommends the need for more education for prostate cancer. They discourage “mass screenings” using PSA because they do not offer education about possible inaccurate test results. The Prostate Conditions Education Council says that the knowledge gap about overall prostate health is poor – 61% of men know “a little” and 20% of men know “nothing” according to a recent report.

The council’s president Wendy Poage said “The main confusion today in prostate cancer centers around two key issues – when to be screened and what to do with the screening results. We must address these questions and encourage men to take appropriate steps to safeguard their health.”

Prostate cancer is the most common non-skin cancer in American men.

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