Screening for prostate cancer

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As men age, the likelihood of being diagnosed with prostate cancer goes up. And since prostate cancer is the most common cancer for American men, how to screen for this disease has been quite controversial.

This week on “Take Care,” Dr. Kirsten Bibbins-Domingo discusses the latest recommendations for prostate cancer screening. Bibbins-Domingo chairs the U.S. Preventive Services Task Force that issued new recommendations in April 2017. Bibbins-Domingo is professor of medicine and of epidemiology and biostatistics at the University of California, San Francisco.

While routine screening can identify early stage cancers, concerns about over diagnosis, false positives, and side effects of treatment such as incontinence or erectile dysfunction led to a controversial 2012 recommendation not to screen for prostate cancer.

But some medical experts did not agree with that recommendation. This year’s guidelines advise men age 55-69 to make an individualized decision about prostate cancer screening with their doctor. Those older than 70 are not advised to have screening.

The prostate & prostate cancer basics

If it weren’t for prostate cancer, many average people might not even know what the prostate is. It’s a gland in men’s lower genitalia area. You can’t see it or feel it, but it’s essential to a man’s normal functioning.

The prostate develops cancer, and it’s the most common form of cancer in men as they age. And Bibbins-Domingo says what’s unique about prostate cancer is that it’s more common as men age. The average age at diagnosis is well into the 70s.

Often times it’s a slow-growing cancer.

“While we are all concerned about cancers, many types of cancers in the prostate are those that won’t cause a man a problem during their lifetime,” Bibbins-Domingo said.

If a man has a father, brother or uncle who has had prostate cancer, it puts them at higher risk. Bibbins-Domingo says patients need to make sure their doctors are aware of family history when they are making a decision about screening.

“Unfortunately we don’t have a lot of good studies about what we should be doing with men who have a family history, whether we should be screening earlier or more often,” Bibbins-Domingo said.

African-American men have twice the rates of developing prostate cancer and if they develop it, they are twice as likely to die. Bibbins-Domingo says that’s also a factor for African-Americans to consider when making the choice to be screened. But again, Bibbins-Domingo says not enough studies exist of African-American men to determine what’s best to do differently.

Change in guidelines

Bibbins-Domingo says the U.S. Preventive Services Task Force makes it’s recommendations solely based on the science of the time.

In 2012, she says what the body of evidence reviewed told them that the benefit to screening is that if 1,000 men are screened, one or two avoid dying.

But while many men who get diagnosed have a type of prostate cancer that won’t cause a problem, most men are treated. Of those diagnosed, 90 percent were treated. Bibbins-Domingo says the harms that come…