Prostate Cancer

“We in the urologic community believe that the PSA test and prostate cancer screening are still very important.” — Li-Ming Su, M.D.

Signs and symptoms: The vast majority of prostate cancer cases are detected with a blood test called prostate-specific antigen, or PSA, with most patients having no symptoms.

Screening techniques: Prostate cancer screening is based on the performance of two tests: a digital prostate examination in conjuction with a PSA blood test.

Health disparities: African-American men are more likely to get and die from prostate cancer than their white counterparts. The disease tends to be more aggressive in black men, which is why screening is recommended for them at a younger age, says Folakemi Odedina, Ph.D., a UF Health Cancer Center health disparities researcher.

Controversy: Currently, opinions are mixed on the PSA test. A U.S. study and a similar European PSA study were published in 2009 with contradictory results, raising the question as to whether the PSA test helps save lives. Because of this, in 2011, the U.S. Preventive Services Task Force began discouraging use of routine PSA testing, sayingit may lead to overdiagnosis and overtreatment. Urologists counter this, saying the PSA saves lives. Further analysis of the two 2009 studies indicated that for younger and healthier men specifi cally, there was a 44 percent reduction in prostate cancer deaths in those who received annual PSA screening as compared to a similar group of men where PSA was not used. As a compromise, the American Urologic Association amended its guidelines, still advocating the test be given, just less frequently, based on patients’ age and risk factors.

Recommendations and treatment: For men ages 55 to 69, screening is recommended every year or every other year. Men with risk factors such as family history or who are African-American should discuss the risks and benefits of earlier screening with their physicians. Typically, early-diagnosed prostate cancer is very treatable by either surgery or radiation. Select patients who are at low risk of developing metastasis from their disease may undergo active surveillance to monitor the cancer and treat only when substantial growth is noted, says Li-Ming Su, M.D., a UF urologist. This is in efforts to avoid potential adverse side effects associated with traditional therapies including urinary and erectile dysfunction.

Below we have a cancer-by-cancer breakdown of screening recommendations.

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