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Blue September

By Dr. Roberta Beals

The second most common cancer in men worldwide, Prostate Cancer has touched us all. The current lifetime risk for men living in the United States is 1 in 6.

Risk Factors are increasing age, genetics and possibly dietary factors. As you age the incidence of Prostate Cancer increases. Ethnicity numbers show Prostate Cancer is more common in Black than White or Hispanic men. Diet with high levels of animal fat or low in vegetables appear to increase risk of Prostate Cancer. Tomato-based products are rich in lycopene, which is a potent anti-oxidant. Newer research models have shown this to be beneficial.

What about screening for Prostate Cancer? The important take home message is to discuss it with your doctor. Just like many areas of medicine it is an individual decision.

The research shows the benefits to modest but here is the latest:

The American Cancer Society (ACS) emphasizes the need for involving men in the decision whether to screen for prostate cancer. Men need to have sufficient information regarding the risks and benefits of screening and treatment to make an informed and shared decision; providing them with a decision aid may facilitate the decision-making process. For men who decide to be screened, the ACS recommends prostate-specific antigen (PSA) testing with or without digital rectal examination (DRE) for average-risk men beginning at 50 years of age. Screening should not be offered to men with a life expectancy less than 10 years. Men whose initial PSA level is greater than or equal to 2.5 ng/mL should undergo annual testing; men with a lower initial level can be tested every two years. The guidelines also recommend beginning screening discussions at age 40 to 45 in patients at high-risk of developing prostate cancer.

The American Urological Association (AUA) updated its guidelines in 2013. The AUA recommends against screening men younger than 40, and also does not recommend routine screening for average-risk men ages 40 to 54, men older than 70, or men with a life expectancy of less than 10 to 15 years. Decisions should be individualized for higher-risk men ages 40 to 54, and the AUA noted that some men over age 70 in excellent health might benefit from screening. The AUA strongly recommends shared decision making in deciding on PSA screening in men ages 55 to 69. The guideline panel could find no evidence to support the continued use of DRE as a first-line method of screening. The AUA stated that a screening interval of two years for men who choose screening may be preferred to annual screening and that screening intervals can be individualized based on baseline PSA level. The guideline noted the lack of evidence for using any tests (eg, PSA derivatives, PSA kinetics, PSA molecular markers, urinary markers, imaging, or risk calculators) other than PSA for triggering a biopsy referral. While the AUA did not recommend a specific threshold for biopsy referral, they did suggest using a threshold of 10.0 ng/mL for men 70 years and older.

For more information see: "Patient education: Prostate cancer screening (PSA tests) (The Basics)"; "Patient education: Prostate cancer screening (Beyond the Basics)" Statistics and research was obtained from an online pear reviewed medical database. August – September 2017.

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