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Effective Prostate Cancer Screening Begins with a Conversation

by Jeffrey Ranta, MD

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Men, have you talked to your doctor about your risks for prostate cancer?

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Jeffrey Ranta, MD
Urologist at UPMC Susquehanna

Experts now recommend that prostate cancer screening tools be used based on individual risks after careful consideration of the pros and cons of early detection. These tools include a rectal exam and the PSA test, which is a blood test that looks at the level of prostate-specific antigen in the blood.

You are considered a higher risk for prostate cancer if you are black, have family members who were diagnosed with prostate cancer before the age of 55, or are known to have the BRCA1 or BRCA2 DNA strand in your family. With these heightened risks, you should talk to your doctor about prostate cancer screening options by the age of 45.

If you do not have any of the risk factors listed above, you can delay the conversation until the age of 50 provided that you do not develop any urinary symptoms or changes in urinary patterns, such as:

  • More frequent urination
  • Nighttime urination, or
  • A weakened urine stream

These symptoms are likely to indicate Benign Prostatic Hyperplasia (BPH). Benign prostate enlargement is common after the age of 50 and should be reported at your next doctor’s exam. Also, blood in the urine should be reported to your doctor immediately.

Why have a discussion before using screening tools? Ongoing research shows that even though PSA as a screening tool can reduce mortality from prostate cancer, the absolute risk reduction is very small.

Put another way, prostate cancer can be a serious disease, but most men diagnosed with prostate cancer do not die from it. While a man’s lifetime risk of developing prostate cancer is 16 percent, his risk of dying from prostate cancer is just 2.9 percent.

Many types of prostate cancer are slow growing. Even without treatment, these may never advance to the point where they might have a negative impact on your health. A 4K score blood test is another screening option that helps determine statistical risk of prostate cancer. 4K score testing clarifies the decision-making process by Urologists decide when a prostate biopsy is an appropriate next plan of action. Historically, it was thought that screening tests can also lead to anxiety, false positives, and even unnecessary treatments. With the advancement in technology, urologists are better able to evaluate risk for aggressive prostate cancer and they have reduced unnecessary biopsies in men. These are the types of considerations that must be weighed in those personalized conversations with your doctor.

If your screening results are positive, the next step is a biopsy to confirm your prostate cancer diagnosis. Based on those results, additional testing may be required to determine the aggressiveness of the cancer. This information can help determine medical treatment and intervention.

When prostate cancer treatment is required, there are options for either radiation implants, or robotic and traditional surgical procedures. The most effective treatment will be based on the location and size of your cancer, along with other considerations unique to your case.