More Definitive Guidance for Prostate Cancer Screening
- “Grey’s Anatomy” star James Pickens Jr., 72, says support from his wife of 42 years helped ease fears about how prostate cancer surgery could affect intimacy, underscoring the importance of emotional support during cancer treatment.
- “Erectile function is so sensitive when we’re dealing with prostate cancer because the nerves that are critical for this function wrap around the prostate; they’re just so intimately connected to the prostate that they can be damaged from a surgical removal of the prostate or through radiation treatment,” Dr. Isla Garraway, a staff urologist in the Veterans Administration (VA) Greater Los Angeles Healthcare System, told SurvivorNet.
- Doctors often recommend sexual counseling after prostate cancer treatment to help improve sexual function, helping address the psychological, emotional, and relationship impacts on sexual health.
- The American Cancer Society’s updated guidelines now recommend PSA screening every two years for average-risk men ages 50 to 69, citing stronger evidence that regular testing can reduce advanced prostate cancer diagnoses and deaths.
- The revised recommendations call for earlier and more frequent screening for higher-risk groups, including annual PSA testing beginning at age 45 for Black men, while also emphasizing active surveillance for low-risk cancers and additional testing before biopsy when PSA levels remain elevated.
Pickens, who has played Dr. Richard Webber on “Grey’s Anatomy” for two decades, adds that his wife reassured him by saying, “Honey, at the end of the day, that’s a lot of fun, but we’re in it for the long haul,'” he recalled. “It’s not what makes our relationship work as long as it has,” according to an interview with People Magazine.
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According to Dr. Robert Smith, director of the ACS Center for Early Cancer Detection, who spoke with AARP, researchers now have stronger evidence that regular PSA testing means fewer men develop advanced prostate cancer or die from it, and doctors have better ways to avoid treating cancers that don’t need it.
WATCH: What Happens If My PSA Test Is Elevated?
Prostate cancer screening may often involve a digital rectal exam and prostate-specific antigen test. This test measures the level of PSA in the blood, and higher levels can indicate cancer. Most cancer diagnoses are caught with screening.
Stronger, more specific advice for higher-risk men
Black men should start prostate cancer screening at 45 and get a PSA test every year through 69. Non-Black men with a father, brother, or son who had prostate cancer should also start at 45, testing every year if that relative was diagnosed before 65 or if more than one relative has had it, and every two years if only one relative was diagnosed at 65 or older.
Men with an inherited gene change such as a BRCA2 mutation should talk with their provider about when to start and how often to test.
For men ages 70 to 74, the decision to continue prostate cancer screening should be made on an individual basis, with screening every two years for those who choose to proceed.
The American Cancer Society (ACS) does not recommend routine screening for men age 75 and older, although exceptionally healthy men between 75 and 79 with a rising PSA level may consider ongoing testing in consultation with their doctor. Screening is not recommended for men age 80 and older under any circumstances.
A Watchful Eye on the PSA
A PSA count is considered high at 3 ng/mL or above for men under 70, or 6.5 ng/mL or above for men 70 and older. A high result should be repeated, ideally 2 weeks to 3 months later. If it stays high, most men should get a prostate MRI and/or a biomarker test before deciding on a biopsy.
Men diagnosed with low-risk cancer should be offered active surveillance as the first option. ACS also does not recommend the digital rectal exam as a screening test.
It’s important to note that despite the updated ACS prostate cancer screening guidelines, the US Preventive Services Task Force still says the decision to get PSA screening should be an individual one for men 55 to 69.
Pickens’ Treatment
Pickens says his father and some of his uncles were also diagnosed with prostate cancer.
“I would have been surprised if I hadn’t gotten it,” Pickens said.
Knowing he’s at increased risk, he started getting his prostate-specific antigen test (PSA) in his early 40s to be able to better monitor his PSA levels and easily detect any subtle increases.
WATCH: What Happens If My PSA Test Is Elevated?
Prostate cancer screening may often involve a digital rectal exam and prostate-specific antigen test. This test measures the level of PSA in the blood, and higher levels can indicate cancer. Most cancer diagnoses are caught with screening.
“I started getting my annual physical 34 years ago. And I started my PSA testing when I was 41,” Pickens said.
Last year, during a routine check-up, Pickens says his doctor noticed those subtle increases in his PSA levels, which prompted more tests.
“My primary said, ‘Yeah, you know what? It’s ticked up some more. I want to send you back to the urologist.” Pickens said.
A biopsy and PET scan helped discover prostate cancer, but it was isolated to one quadrant of the prostate.
Not wasting any time, Pickens chose to undergo a robotic radical prostatectomy.
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Prostate cancer surgery is a highly effective treatment for many men with localized disease. The goal is to remove the prostate gland and surrounding tissues (such as seminal vesicles) to eliminate cancer. This procedure is called a radical prostatectomy.
“The robot has really revolutionized our ability to operate in that small space, to be able to apply fine dissection, tremor, less movement of the hands to dissect these nerves off of the prostate, and at the same time, suture the bladder back to the urethra after the prostate is removed,” Dr. Randall Lee, a urologist at Fox Chase Cancer Center in Philadelphia, tells SurvivorNet.
“Historically, with open surgery … one of the big risks of that was leakage of urine at that connection site. Nowadays, that is less of a concern with the ability to visualize that area in the pelvis.”
Choosing the right surgical approach involves a detailed conversation with your urologist or oncologic surgeon, something similar to what Pickens had with his care team before settling on robotic radical prostatectomy over radiotherapy.
“We caught it really early, and so they thought that would be the best route to take. I do have a rare variant that you don’t see very often. They wanted to err on the side of caution and keep an eye on it,” Pickens said.
Pickens told ABC News that his latest scans found “no detectable” signs of cancer.
WATCH: Robotic Surgery Vs. Open Prostate Surgery For Prostate Cancer
More on Robotic Prostatectomy
A robotic-assisted laparoscopic prostatectomy (RALP) is a minimally invasive procedure that uses a robotic surgical system, such as the da Vinci Surgical System. The surgeon operates from a console, controlling robotic arms that hold surgical instruments and a high-definition 3D camera.
Tiny incisions (usually 5-6) are made in the lower abdomen to insert the instruments. The robotic system translates the surgeon’s hand movements into precise actions inside the patient’s body. The camera provides magnified views that help in identifying nerves and structures crucial to continence (bladder and bowel control) and sexual function.
Both types of prostate cancer surgeries [robotic and open surgery] carry the same general risks, including bleeding, infection, and complications related to anesthesia. However, functional outcomes, particularly urinary continence and erectile function, are of major concern for most patients.
Most men experience some degree of incontinence initially. Robotic surgery may lead to a quicker return to continence due to better precision in preserving structures around the urethra. Long-term incontinence rates are similar between both methods with experienced surgeons.
Nerve-sparing techniques can help preserve erectile function in eligible patients. Robotic surgery may offer a better chance at nerve preservation, though outcomes depend largely on the patient’s preoperative function and cancer location. Full recovery of sexual function can take months or more than a year.
Prostate Cancer Screening and Warning Signs
When you do get screened for prostate cancer, your doctor will run a few tests, including a PSA test as discussed earlier. Your doctor may also conduct a digital rectal exam (DRE) to check your prostate for lumps.
Depending on the results of these tests, imaging scans and a biopsy may be ordered.
WATCH: How Gleason Grade Determines Treatment
Prostate cancer does not always behave the same in every man it affects. The cancer can be considered “low-risk” and can be slow-growing, and treatment might not be necessary. In other men, the cancer may grow faster or more aggressively, requiring more immediate treatment. Because of this, there is some debate about screening.
Symptoms of prostate cancer may include:
- Urinating more often
- Waking up in the middle of the night to pee
- Blood in your urine
- Trouble getting an erection
- Pain or burning when you urinate
- Pain in your back, hips, thighs, or other bones
- Unexplained weight loss
- Fatigue
If You’re Diagnosed With Prostate Cancer, What to Expect for Treatment?
After testing and establishing your risk, your doctor will discuss possible treatment options. These may range from active surveillance to more aggressive options, including surgery and radiation therapy.
WATCH: Coping emotionally after a prostate cancer diagnosis
Surgery is an option for men in any risk group for prostate cancer that hasn’t spread outside of the prostate gland. The type of surgery most often used is called a radical prostatectomy.
During the procedure, the surgeon removes the entire prostate, along with some tissue around it, including the seminal vesicles that release fluid into the semen. Your doctor can perform this through a traditional open procedure with one large or several small incisions, called laparoscopic surgery.
WATCH: Sexual Function Recovery After Prostate Cancer Surgery
Surgery side effects may include erectile dysfunction and urinary incontinence. Fortunately, the side effects are usually temporary, and there are ways to help you manage them.
“Erectile function is so sensitive when we’re dealing with prostate cancer because the nerves that are critical for this function wrap around the prostate; they’re just so intimately connected to the prostate that they can be damaged from a surgical removal of the prostate or through radiation treatment,” Dr. Isla Garraway, a staff urologist in the Veterans Administration (VA) Greater Los Angeles Healthcare System, told SurvivorNet.
Doctors often recommend sexual counseling after prostate cancer treatment to help improve sexual function. This approach actively addresses the psychological, emotional, and relationship impacts on sexual health.
Radiation therapy is often done when prostate cancer is caught early and confined to the prostate gland.
Finding Resources And Support
For patients and families navigating prostate cancer or another serious illness like a cancer diagnosis, gaining access to new treatment or trials can feel overwhelming. That’s why SurvivorNet encourages patients to use its proprietary Clinical Trial Finder, a free tool designed to help patients identify relevant trials quickly and easily.
Every year, new early-phase studies come online, each one representing another step forward in disease management.
SurvivorNet’s AI-powered “My Health Questions” tool was also built with patient needs in mind to give patients and their caregivers access to health information vetted by professionals right when they need it.
Learn more about SurvivorNet's rigorous medical review process.
