Prostate Cancer Screening – Clear as Mud

simple math, right? Well, that about explains the look I sometimes get when trying to explain prostate cancer screening to some of my patients. The topic can be hotly debated, controversial, and confusing even to medical experts. Yet, as a urologist I am charged with knowing how to concisely and eloquently have an informed conversation with men and their family members about prostate cancer screening, diagnosis and treatment, all within the succinct 20-30 minute office visit. No doubt, this conversation is often confounded by the misinformed “friend” or misguided advertising regarding the latest treatment in prostate cancer. This past April, there was quite the hype in the media regarding a change in recommendations by the United States Preventive Services Task Force (USPSTF), who changed their recommendation of prostate cancer screening from a ‘D’ back to draft recommendation of a ‘C’. This was a big deal.

Let’s break it down; who is the United States Preventive Services Task Force (USPSTF), what is the prostate and prostate cancer screening, and what does it all mean for the men of Montana?

So just who is the United States Preventive Services Task Force (USPSTF)? The United States Preventive Services Task Force (USPSTF) is a body of independent volunteers of primary care and prevention experts who systematically review medical evidence to develop official recommendations for clinical preventive services (1). Like childhood report card grades, their recommendations come with a letter grade, ‘A’ and ‘B’ is good (offer/provide service), ‘C’ not so good, but passing (offer/provide service for selected patients depending on individual circumstances), ‘D’ not recommended (discourage use), and ‘I’ for incomplete/insufficient evidence to make an official recommendation. Furthermore, it’s from these recommendations that payers (think insurance companies) create their own policies on what tests and procedures they will pay for. Clearly, one can quickly see that these recommendations carry enormous financial and health implications –doctors, patients, and insurers alike take them very seriously.

What in the world is the prostate (pronounced “Pra-state”) and why do men have one? The prostate is a walnut to small plum sized gland found below the bladder in men; the urethra (pee tube) runs through it and its job is to produce the fluid in the ejaculate to protect and nourish sperm for reproduction. For the most part it grows during puberty and then again during middle age. For such a small gland it’s often at the center of a host of men’s health issues.

What is Prostate Cancer Screening? Prostate cancer is the second most common cancer in American men, behind skin cancer. This year’s estimates by the American Cancer Society estimate greater than 160,000 new cases will be diagnosed and over 26,000 deaths will be caused by prostate cancer with a risk of diagnosis of 1 in 7 (14.28%) during a man’s lifetime (2). Prostate cancer screening typically entails both a yearly digital rectal exam and a blood test for prostate specific antigen (PSA) to find possible prostate cancer in men who would benefit from knowing if they have prostate cancer. The obvious question here is, “won’t all men benefit from knowing if they have prostate cancer?”—I will save you a rather lengthy explanation with lots of commentary—too much to include here, but in general, the gentlemen who would benefit the most from knowing if they have prostate cancer, are those who fall between the ages of 55-69. This recommendation, which is supported by the USPSTF and American Urological Association (3,4), leans on the biological properties of prostate cancer, which is usually slow growing cancer, as well as the life expectancy of the average man beyond the age of 70. These factors plus the morbidity that comes both with the diagnoses and treatment of prostate cancer drives these screening recommendations.

So, what does it all mean for you? The change by the USPSTF in its draft recommendation for prostate cancer screening has incredible public health implications. The success found from decades of prostate cancer from prior to 2012 -when the USPSTF originally changed its recommendation to a grade ‘D’ from a ‘C’- was jeopardized with the change. We know from long term studies, that prostate cancer screening results in a 30-50% reduction in prostate cancer metastases and death and it was the strength and longer follow up of these studies to why the USPSTF shifted its stance back 5 years later. As we find ourselves in “Cancer Awareness Month” of November and many men participating in prostate cancer awareness as “no shave Movember”, if you are a male with a family history of prostate cancer, are between the ages of 55-69, or older than 69 and in exceptional health, you should talk to your primary care physician or urologist about prostate cancer screening.

About Dr. Slater

Dr. Richard “Rick” Slater specializes in adult and pediatric urology. He is board eligible in urology and is actively involved in the American Urological Association, Endourological Society and the American College of Surgeons.