It’s not the subject any man wants to talk about. Prostate cancer screening. Hey, no one likes the dentist either. But, it’s just one of those items we check off the list as we age. The general recommendation for men of average risk is to screen between the ages of 40 and 50.
Nice, I have at least eight years to procrastinate on that one. If you have a genetic predisposition or strong family histories of prostate cancer, toss aside the recommendation. Get screened now. Healthy men, but still high-risk, should start at age 40.
Two tests are involved to screen your prostate. One you’re going to recoil in horror and wonder why technology hasn’t advanced. It’s the digital rectal exam. Your doctor inserts a gloved, lubricated finger into the rectum to feel for lumps or abnormalities on the prostate.
The other test measures the level of prostate-specific antigen (PSA) in the blood. PSA levels can be elevated in men that have prostate cancer. It’s not the end-all test. An elevated PSA reading can be the result of other factors, including race and age. Medications, procedures, an enlarged prostate and infection can all affect the PSA levels in the blood.
Treating Prostate Cancer
If your screening turns up an early prostate cancer diagnosis, the treatment options are numerous. In fact, a recent study has shown that localized, low-risk prostate cancer can be watched. There’s no need for what physicians have dubbed ‘overtreatment.’
A recent study published in JAMA showed the use of surveillance for low-risk patients rising sharply between 2010 and 2013. 40 percent of all cases were using the ‘watch and wait’ method over aggressively treating prostate cancer.
Between 1990 and 2009, the number of cases that were being monitored only stood at 7-14 percent.
Analyzing the data from 10,472 men in the Prostate Strategic Urologic Research Endeavor, the UCSF researchers were able to show the rise in active surveillance, or ‘watchful waiting.’
The data analyzed included tumors classified as cT3aNoMo or lower managed with radiation, androgen deprivation, prostatectomy or active surveillance.
The authors hope the study pushes back on the criticisms of screening for prostate cancer leads to overtreatment.
“Given that overtreatment of low-risk disease is a major driver of arguments against prostate cancer screening efforts, these observations may help inform a renewed discussion regarding early detection policy in the United States.”
The rise of watchful waiting has been steady since 1990 as doctors and patients become more aware of the treatments and how to approach various stages of prostate cancer.
Androgen deprivation for moderate and high-risk tumors fell sharply during the study period. After 2010, the treatment method dropped from 10 and 30 percent to 4 and 24 percent respectively.
Prostate Cancer and You
First thing, if you are in the age range that fits your risk, get screened. Yes, it sucks. But, so does letting it grow into a high-risk tumor. Quick exam or death? It’s not a hard question to answer.
I joked about procrastinating for the test, but I’ll bite the proverbial bullet and get screened. It wouldn’t be a laughing matter looking back and saying ‘if only.’
Finally, talk to your doctor. Active surveillance may be the only treatment you ever need. Your doctor will lay out all the potential treatment paths and scenarios.
In the end, watchful waiting only works if you know something is amiss. Get screened.
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