By: George Beauregard, DO, Chief Population Health Officer
The recent news about President Biden’s health has brought prostate cancer back into the national spotlight and a topic during water cooler conversations.
Prostate cancer is known to be a worldwide health burden. Older age and family history of prostate cancer are well-established risk factors. The average age of men at diagnosis is about 67. The risk is higher in African American males. Males at high risk should consider beginning screening at age 40.
Although prostate cancer is a serious disease–it is the second-leading cause of cancer death in men in the U.S.–most men who develop it do not die from it. Many cases are detected early and are treatable. In the 1990s, U.S. physicians adopted the prostate-specific antigen test—or PSA—to identify prostate cancer. But an elevated PSA does not necessarily mean a cancer diagnosis, as benign prostatic hyperplasia (a noncancerous increase in size) can cause an elevated PSA as well. To some extent, this resulted in too many men getting unnecessary prostate biopsies, procedures and treatments. While the use of a PSA test to monitor the progression of established disease is undisputable, its use as a screening tool remains debatable in the medical community due to issues related to potential harms and benefits.
In 2012, the U.S. Preventive Services Task Force, an independent panel of experts, recommended against routine screening with PSA for all men at average risk. In 2017, owing to new evidence from credible studies, they changed their recommendation. The current recommendation focuses on men having a conversation with their health care providers – the so-called shared decision-making approach – about the risk of prostate cancer and the risks and benefits of screening. It recommends against routine PSA-based screening for men aged 70 and older, as the potential harms outweigh the benefits. It’s known that about half of men over 70 have some cancer in their prostate but no symptoms; the cancer is then usually indolent and harmless. With screening, many of those abnormal results might result in unnecessary surgery and/or radiation that likely wouldn’t confer any survival benefit.
The incidence rate of prostate cancer is about 112 per 100,000 males and has increased by 3 percent per year during the past 10 years. While the incidence rates for prostate cancer that is confined to the prostate have decreased, rates for prostate cancer that has spread to areas near and far from the prostate—like to bone–have increased. The American Cancer Society reported that, between 2011 and 2019, on an annual basis, the incidence of advanced prostate cancer rose by approximately 4.5 percent.
It’s been reported that President Biden had not undergone a PSA test since age 72, and that is consistent with the guidelines.
As is the case with any health concerns you have, the overall takeaway is the importance of having a discussion with your trusted healthcare provider about your specific risks and the benefits associated with PSA-based prostate cancer screening.
