Oncologist Brian Persing discusses the importance of prostate cancer screenings and available prostate cancer treatment options.
When do we need to start having that conversation about screening?
Most men need to start having that conversation with their doctor around age 50. Although, there are certain populations, especially the African-American population, as well as men that have had one or more family members with a history of prostate cancer, that need to think about screening earlier. You need to start looking at screening at about age 40 if you have two family members who’ve had prostate cancer – including first degree relatives like brothers or fathers and sometimes even second degree relatives like uncles. If you are African-American or have had at least one family member with prostate cancer, you should begin screening at age 45.
Who do I talk to about prostate cancer screening?
Typically, any health care professional, especially primary care, is where that discussion starts. Many times if there’s an abnormal test, they’ll refer you to somebody else, typically a urologist. If you are already seeing a urologist for other issues, they will actually have those discussions with men as well.
What are the screening options?
The most favorable screening option that most men prefer is the PSA, which is just a blood test. Although, along with the PSA, urologists typically recommend a digital rectal exam, which is to determine the size of the prostate and if there are any abnormalities there. It’s obviously less exciting for men.
The biggest problem with the PSA is it can define changes in the prostate for other reasons such as prostatitis, which is just inflammation of the prostate. The PSA alone doesn’t necessarily mean if it’s elevated that there is prostate cancer there.
What happens if screening result shows an abnormality?
There are a couple options. One option, depending on age and how high the PSA is, can be to repeat the PSA test in six weeks or three months. Another option will be to proceed with an ultrasound to look at the prostate itself. Sometimes, if the PSA is high enough, you can consider a biopsy of the prostate.
What are the best options for prostate cancer treatment?
There are two schools of thought on prostate cancer now. That is, many men are diagnosed with prostate cancer that never die from prostate cancer. About one in seven men are diagnosed, but only about 1 in 39 men die of prostate cancer. Sometimes we know that with what we call lower Gleason scores. So, when they do the biopsy, we confirm the prostate cancer, but it doesn’t look very aggressive, at least not in the microscope. One option is watching with PSAs and maybe intermittent ultrasounds. For PSAs that are higher, Gleason scores that are higher (seven and up), many times we’ll recommend some sort of intervention. That could be surgery, radiation or hormonal therapy. It’s really one of those situations where there are several acceptable options depending on what your pathology shows.