Get regular prostate exams, experts advise

September 20, 2016 Providence Health Team

Scheduling an appointment for a prostate exam is probably one task most men would like to put off as long as possible. But they shouldn’t. Cases of aggressive prostate cancer are on the rise, according to new research.

One possible explanation is that screening guidelines have become more relaxed, leading men to believe they don’t need to get regular exams.

According to a report from Northwestern Medicine, there was an alarming rise in the number of new cases of metastatic prostate cancer from 2004 to 2013. The largest increase in cases occurred in men ages 55 to 69. The authors of the study say this is particularly troubling because “men in this age group are believed to benefit most from prostate cancer screening and early treatment.”

The researchers question whether the increase is the result of fewer men getting screened early, or of the disease becoming more aggressive. It might be a combination of both, they say.

Get screened early and regularly

“The earlier we find cancer, the earlier we’re able to treat it with less side effects,” says Tim Wilson, M.D., chair of urology at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, Calif.

“We’ve forgotten that prostate cancer is the second cause of cancer death in men, exceeded only by lung cancer,” he says. “And it’s the most common disease in men.”

PSA test

The PSA test is a common blood test used to screen for prostate cancer by measuring the amount of prostate-specific antigen (PSA) in the blood. PSA is a protein produced by both cancerous and noncancerous tissue in the prostate.

Low PSA test results—usually about 4 nanograms per milliliter of blood or less—suggest that a man does not have prostate cancer. Higher levels—more than 10 nanograms per milliliter of blood—may indicate the presence of cancer. With higher PSA results, a number of factors also need to be taken into account. For example, PSA numbers rise naturally with age and can vary depending on ethnicity.

The PSA test is not a perfect test for detecting early prostate cancer. It also picks up on other conditions, such as an enlarged or infected prostate, and this can lead to false-positive cancer results. Age can trigger a false-positive result, as well as certain medications. Because physicians aren’t able to determine the reason for abnormal PSA numbers in a single test, a positive result may require the patient to get additional tests or a biopsy, which introduces other potential complications such as infection.

New methods of imaging for early detection

As new, sophisticated methods for testing for early signs of prostate cancer are developed, experts hope to reduce the number of unnecessary biopsies. Dr. Wilson says the new testing methods are better and more refined than PSA tests alone.

The 4Kscore® test, for example, combines the results of different types of PSA to get an overall score that reflects the chance that a man has prostate cancer. This test is useful for men with slightly elevated PSA levels, to help determine if they should have a prostate biopsy at all. It may also predict the likelihood of cancer spreading to other parts of the body.

Advancements in MRI-ultrasound technology have significantly helped the field of prostate imaging, allowing urologists to perform more accurate biopsies.

The multiparametric MRI may be used on a patient who tests positive for cancer. The scans can help determine the extent of the disease and how aggressive it might be, factors that greatly affect the patient’s treatment options.

It may be in your genes

Genetic tests offer a more sophisticated picture of a man’s risk for prostrate cancer. Men who have defects in a cancer-suppressing gene known as BRCA are at high risk for aggressive prostate tumors. In women, defective BRCA genes are risk factors for breast and ovarian cancer.

Dr. Wilson says genetic tests can help determine if a patient requires an aggressive testing schedule or treatment, even if he had a previous negative biopsy.

He advises any man who receives a first diagnosis of prostate cancer to do some research and seek out a variety of opinions before making decisions. “It’s important to find a cancer center that routinely treats prostate cancer. Look for expertise,” he says.

Risk factors for prostate cancer

The three most recognized risk factors for prostate cancer in the U.S. are:

  • Age: Prostate cancer is rarely seen in men younger than 40 but the risks rise rapidly with each decade.
  • Ancestry: The risk of developing and dying from prostate cancer is dramatically higher among African American men. The risk is slightly less for Caucasian men, while native Japanese men have the lowest risk of developing the disease. 
  • Family history of prostate cancer: The inherited risk of prostate cancer has been estimated to be as high as 60 percent.

Many providers, including Dr. Wilson, recommend that men should still have a PSA and prostate exam at 50. If they have prostate cancer in their family history or if they’re of African American descent, screening should begin at 40. Be sure to speak with your own provider to determine the right screening and timing for you.

“With newer tests, better imaging and genetic analysis of the cancer cells, we are now better at understanding which men truly need treatment,” he says.  “These advanced methods also help us determine which cancers can be safely monitored without aggressive treatment.”

If you’re concerned about prostate cancer or have questions about the screening methods, talk to your provider. You can find a Providence provider here.

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