Should Older Men Be Screened for Prostate Cancer?
- Warren Buffett’s prostate cancer diagnosis nearly a decade ago reinvigorated a conversation among oncologists that’s been a point of controversy for years: Should older men be screened and treated for prostate cancer?
- In men over the age of 70, the task force that develops recommendations for clinical preventive services recommends against basic testing for prostate cancer using the PSA. Experts say most men who are diagnosed with prostate cancer later in life will be able to manage the disease.
- Among the treatment options available to men who have been diagnosed is a form of very active surveillance, in which blood levels are monitored. When prostate cancer has spread elsewhere in the body, specialists say a more aggressive treatment approach is often considered.
Now 91, the chairman and chief executive officer of the investment holding company, Berkshire Hathaway, was diagnosed with early-stage prostate cancer in April 2012. He successfully completed 44 days of radiation treatment in September 2012 — five months after his diagnosis.Read More
— Benjamin J. Davies MD (@daviesbj) April 18, 2012
PSA is a protein secreted by the prostate gland; a large amount of PSA in a person’s body can indicate that cancer cells are growing. But that isn’t always the case.
“The problem with PSA testing is that it’s not totally specific for prostate cancer,” Dr. James Brooks, a urologic oncologist at Stanford Medicine, tells SurvivorNet. “It can also reflect enlargement of the prostate, which most men get at some point in their lifetime.” It can also be a product of infection or inflammation, he says.
The point is that the PSA test isn’t a perfect test, says Dr. Edwin Posadas, director of the Translational Oncology Program at Cedars-Sinai Medical Center in Los Angeles. And Buffett’s diagnosis nearly a decade ago reinvigorated a conversation among oncologists that’s been a point of controversy for years.
Screening Older Men for Prostate Cancer
Most men will develop prostate cancer at some point in their lives if they live long enough, Dr. Geoffrey Sonn, assistant professor of urology at Stanford Medicine, tells SurvivorNet. But most men will not die from prostate cancer. In addition, because prostate cancer is such a slow-growing type of cancer, it’s much more likely that older men will die of something other than prostate cancer.
So, should older men be screened for prostate cancer? This question has come up time and again, and the answer seems to depend on who you ask or what hospital you go to. (If a man has an elevated PSA level, he has somewhere between a 20% to 40% chance of having cancer, according to Dr. Brooks.)
The United States Preventive Services Task Force is an independent panel of experts that reviews the effectiveness and develops recommendations for clinical preventive services. It says that for men ages 55 to 69, the decision to undergo periodic PSA-based screening for prostate cancer should be made in consultation with a doctor, and it is not. However, the task force recommends against this form of testing for men aged 70 and older. Buffett was 81 years old when he underwent PSA testing, which led to his prostate cancer diagnosis.
The task force says its recommendation is based on the fact that many men will experience potential harm from screening using the PSA-based test. Dr. Jim Hu, a urologic oncologist at Weill Cornell Medicine, reiterates this point: “There are harms of PSA testing, because you may over-diagnose, or you may find prostate cancers in men who were more likely to die of something else, or that you would subject these men to biopsies which are uncomfortable, and have about a 2 percent to 3 percent risk of a serious infection.”
What is Active Surveillance?
Active surveillance is a watch-and-wait approach for men who have low-risk prostate cancer. This means you have a small number of cancer cells found in your biopsy, a low PSA level and a low-grade cancer.
With low-risk prostate cancer, your risk of cancer traveling outside the prostate and spreading to other parts of the body is “really, really low,” Dr. Stephen Freedland, a urologist at Cedars-Sinai Medical Center, tells SurvivorNet, “so anything we do is going to be over-treatment.”
If you do opt for active surveillance, you’ll regularly need a PSA test, rectal exam and high-quality imaging tests, which can identify minuscule yet important changes.
“We can actually see some of the metabolic information within the cells through our next-generation imaging and find high-risk areas that are or are not changing in a patient to let us know, yeah, that cancer’s still sleeping,” Dr. Posadas says.
Different Guidance On Screening Depending on Race & Family History
Just because men over age 70 shouldn’t get screened using the PSA test doesn’t mean men should never be screened for this type of cancer. There are specific genetic factors that could put men at higher risk for developing prostate cancer.
Black men, for example, fall immediately into a high-risk category, according to Cedars-Sinai’s Dr. Posadas. Men whose fathers or brothers had prostate cancer are at two to three times the risk of the average man living in America of having prostate cancer, as well.
“Those pieces of information are critical to bring forward in an examination when you’re seeing your doctor,” he says. If you fit this genetic profile, you should start screening for the disease as early as age 45.
Posadas also recognizes that the PSA test is not a perfect test, “but at the same time, the amount of information that can be gained from that is tremendous, and it can be a life and death type decision that is made.”
In other words, talk to your doctor about the best option for you.
Contributing: SurvivorNet staff