Prostate cancer screening guidelines evolving

September 27, 2023 | by NorthShore – Edward-Elmhurst Health

Guidelines around prostate cancer screening can often generate more questions than answers, as there have been cultural shifts over the years around concerns of over-screening and potential negatives resulting from under-screening.

“We want screening to pick up the kind of clinically significant prostate cancers [that] patients need to know about,” said NorthShore Urologist Hayley Silver, MD, who acknowledged that patients often receive inconsistent messaging around screening.

Patients with no particular risk factors, family history, or genetic mutations should consider initial PSA (prostate specific antigen) screening with a blood test to measure the level of the PSA protein at age 45, said Dr. Silver.

For patients who have a family history of the disease or have inherited mutations of BRCA1 or BRCA2 genes, PSA screening test is recommended at age 40. African American men also face a higher risk for prostate cancer.

Initial screenings can help physicians determine overall risk for prostate cancer by comparing a patient’s PSA level to the average score for their age, explained Dr. Silver. The goal is not to find low-risk, slow growing cancers.

“It’s amazing how much the culture and practice of screening has changed in the last 10 years. I try to provide as much information from a global perspective to help patients through a shared decision- making process around screening,” said Dr. Silver. An individual’s risk tolerance also plays into the conversation, she added.

The results of the initial PSA test can guide future recommendations. For example, a PSA score can be low enough that the next screening is not recommended for another 2-4 years, said Dr. Silver. For average risk patients, screening is generally recommended every 1-2 years. 

For patients with higher-than-average PSA scores for their age, additional screening methods including prostate MRI and other biomarker tests can be used to further stratify overall risk. “The world of prostate cancer screening in diagnosis has expanded dramatically in the last 10 years,” added Dr. Silver.

Screening for many men in their 50s also opens the door to address other urologic concerns that may or may not relate to a cancer risk but can have major impact on quality of life, said Dr. Silver. Whether it’s urination or sexual function problems, many men are uncomfortable talking to their primary care physician.

“Eighty percent of men will deal with some kind of uro/bladder issue in their life and in the long-term, the sooner you identify the problem, the better the options are for resolving it and improving overall health,” said Dr. Silver.

“It’s never too soon to talk about these issues with a urologist and I hope we can move toward removing the stigma in talking about these concerns. I meet patients on a weekly basis who say they wish they had been referred sooner.”

There are many new and innovative medications and procedures to treat common conditions like benign prostate disease, which can significantly improve quality of life, said Dr. Silver.

Bladder health and sexual function issues can be a manifestation of other diseases including diabetes, neurological and heart conditions, another reason it is important to discuss concerns with a urologist, added Dr. Silver.

For more information on prostate cancer symptoms, screening and treatment or to schedule an appointment, talk to your primary care doctor or search our experienced urologists.

Learn more about our urology services and cancer services.

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