28 Aug Identifying the Patient at High Risk for Prostate Cancer
Submitted by: Christopher R. Williams, MD | Urology Consultants, Inc
Prostate Cancer (PC) is very common amongst American men. Approximately 175,000 new cases will be diagnosed in 2019. PC has been a topic of much discussion and debate over the past 5 years. The United States Preventive Task Force (USPSTF) is largely responsible for much of this due to recommendations against non-invasive PC screening, namely the PSA (Prostate Specific Antigen) blood test. The basis of their argument has been that, because most prostate cancers are not aggressive and treatments have historically been fraught with side-effects, screening should not be done. Their conclusions showed an extreme ignorance of the broad landscape of PC. However, considering that no one on the USPSTF was a PC specialist this was not surprising.
What those of us who actually treat PC know is that PC can be a very deadly and debilitating disease when not caught and treated early. Despite screening and treatment measures significantly more advanced than before PSA came onto the scene, approximately 31,000 men will still die this year from PC. In their zeal to prevent over-diagnosis and treatment of non-aggressive prostate cancer, the USPSTF effectively pronounced a death sentence on men who are at high risk for developing aggressive prostate cancer.
Who has a higher risk for aggressive prostate cancer?
The greatest at risk are men who are African American or have a family history of PC. Even when challenged to the point of involving Congress, the USPSTF would only cede that these men should be informed of the increased risk of PC and the risks/benefits of screening. Yet, there was no recommendation FOR screening of these high-risk individuals. So, without any further guidance, most primary care physicians continue to screen these high-risk individuals as if they are at average risk, beginning at age 55. Sadly, by this age many high-risk individuals have already developed aggressive cancer that is incurable and will ultimately lead to their death — a very morbid and painful death.
What can or should we do as prostate cancer specialists?
The most important thing we can do is to effectively identify these individuals as high-risk and to screen them early. Because these individuals are high-risk, screening should be aggressive and comprehensive because the stakes are high. The National Medical Association and the Prostate Health Education Network recommend that screening in high-risk individuals should begin at age 40 and include a PSA blood test as well as a digital rectal exam. Having seen far too many young men suffering from incurable PC, I agree with these screening recommendations and advocate for them as often as possible. Hopefully, in doing so many lives will be saved and/or spared the agony of aggressive prostate cancer.