Changes in Prostate Cancer Detection Methods - Improvements Ahead
Prostate Cancer Screenings: A New Approach to Early Detection
The image of a prostate examination, often depicted in comedic settings, may not accurately represent the current state of prostate cancer screenings. While it is true that prostate-specific antigen (PSA) tests can lead to overdiagnosis, resulting in unnecessary procedures, the prostate screening landscape has evolved significantly in recent years.
Understanding Prostate Cancer
The prostate, a gland located beneath the bladder, plays a critical role in semen production. Approximately one in eight men are likely to be diagnosed with prostate cancer during their lifetime, typically after the age of 65. Prostate cancer is the most common non-skin cancer for men.
'"Prostate cancer is a very common condition in older men," says Dr. Daniel Lin, a urologist at the Urology Clinic at UW Medical Center and Fred Hutch Cancer Center, and the Chief of UW Medicine Urologic Oncology. "But many of the cancers men get, particularly as they age, are the type of cancers that might never harm them."'
Slow-growing prostate cancers may not pose an immediate threat, while more aggressive forms require immediate treatment.
Prostate Cancer Screenings: What You Need to Know
Screening for and diagnosing prostate cancer consist of multiple procedures and tests, with the decision to screen dependent on a conversation with a primary care physician. The core principle surrounding prostate cancer screening today is shared decision-making.
Here are the key tests used to screen and diagnose prostate cancer, along with their benefits and drawbacks:
The PSA Test
The PSA test measures the level of prostate-specific antigen in the blood. Elevated levels can suggest the presence of prostate cancer, prompting further diagnostic steps. However, PSA levels may also be elevated due to other factors like an enlarged or inflamed prostate.
In some cases, the PSA test has been criticized for leading to overdiagnosis or overtreatment of prostate cancer. Misinterpreted results or the diagnosis of unnecessary cancer treatment can cause unnecessary anxiety and potential complications like bleeding or infection. Nevertheless, the PSA test is essential for the early detection of aggressive cancers.
'"I think we've learned more about who to do PSA screening on - for example, we don't necessarily need to do it on older patients with less life expectancy," says Lin. "There are tools that we use that combine age plus family history that help to identify if a patient needs a biopsy."'
The Digital Rectal Exam (DRE)
Once a standard part of routine physical exams for older men, the digital rectal exam has taken a step back in the 2023 American Urological Association's guidelines, which Lin co-chaired.
'"A digital rectal examination by itself has a poor association with a diagnosis of prostate cancer," says Lin. "But if the PSA is elevated, then a digital rectal examination actually does lend us some information."'
Now, the AUA only recommends a digital exam for patients with elevated PSAs to aid in cancer risk evaluation.
The Promise of Imaging
The use of imaging, such as magnetic resonance imaging (MRI), is becoming more common among urologists. An MRI can help determine if a biopsy is necessary and identify the specific region of the prostate for biopsy.
'"I think imaging is certainly taking on a new role," says Lin. "There is a lot of promise in using MRI for prostate cancer evaluation."'
What Happens After a Prostate Cancer Screening
If initial PSA levels are normal, a baseline has been established for future comparisons. If PSA levels are elevated, the doctor may recommend an MRI or DRE to determine if a biopsy is necessary. Following a biopsy, medical teams will identify if there is cancer and assess its aggressiveness.
Aggressive cancers may require surgery, hormone therapy, radiation, or chemotherapy, while less aggressive cancers may benefit from active surveillance with regular follow-ups. Although a prostate cancer diagnosis can be frightening, active surveillance can help minimize the risks associated with surgery or radiation, such as loss of sexual function and incontinence.
'"And active surveillance has been proven to be an effective strategy for many prostate cancers," says Lin, who is the principal investigator for the Canary Prostate Active Surveillance Study. "10 years after diagnosis, less than 2% of patients in the study who opted for active surveillance developed metastatic cancer. Only 0.1% died from prostate cancer."'
When to Begin Prostate Cancer Screenings
According to the American Urological Association's guidelines, men should receive a baseline PSA test between the ages of 45 and 50. For those with a family history, African American men, or those with genetic mutations raising prostate cancer risk, early screening may begin as early as 40 years old.
'"We feel like that's a reasonable ask," says Lin. "It's a rather low-intensity recommendation that we feel can catch cancer earlier."'
In the near future, an aspirin a day may offer prostate cancer protection[1]. Research shows that long-term aspirin use may reduce prostate cancer risk by 19%[2][3]. However, the FDA has not approved aspirin for this purpose.
If you've been avoiding prostate cancer screenings, rest assured that the process has become less invasive, potentially saving lives.
References:[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6316750/[2] https://cancerpreventionresearch.aacrjournals.org/content/13/1/37[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4063143/
- The prostate, a gland essential for semen production, can develop chronic diseases like prostate cancer, which is the most common non-skin cancer for men, particularly among older males.
- Misinterpreted PSA test results can lead to overdiagnosis and overtreatment of prostate cancer, causing unnecessary anxiety and potential complications.
- The promise of imaging has emerged in the form of magnetic resonance imaging (MRI), which can help determine if a biopsy is necessary and reduce the risk of unnecessary treatments.
- Nutrition and health-and-wellness practices, such as the use of aspirin, may moderate the risk of developing prostate cancer, potentially offering benefits for mens-health and early detection.
