Another round about assault on the early detection of prostate cancer? Systematic “lowering the guard” of the unsuspecting male who sees this and rationalizes decision, after the discussion, not to be screened for prostate cancer. Is this all by design?
When recent guidelines questioned benefit of the digital rectal exam in the early detection of prostate cancer, several news outlets made it a story of “is the DRE” really necessary. One of my news feeds that automatically feeds into my twitter account (updated daily news about prostate cancer) was noted by Team Winter. Winter’s father passed away with a very rare and aggressive form of prostate cancer at a young age. Visit her website…it is moving. Below is her response to the feed alluded to on my twitter page. Of note…in posting that feed that did not mean I agreed with the content, it is just what is in the news for that day.
American Cancer Society recommendations for prostate cancer early detection
The American Cancer Society (ACS) recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information.
The discussion about screening should take place at age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).
This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age).
After this discussion, those men who want to be screened should be tested with the prostate specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.
If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the patient’s general health preferences and values.
Men who choose to be tested who have a PSA of less than 2.5 ng/ml, may only need to be retested every 2 years.
Screening should be done yearly for men whose PSA level is 2.5 ng/ml or higher.
Because prostate cancer grows slowly, those men without symptoms of prostate cancer who do not have a 10-year life expectancy should not be offered testing since they are not likely to benefit. Overall health status, and not age alone, is important when making decisions about screening.
Even after a decision about testing has been made, the discussion about the pros and cons of testing should be repeated as new information about the benefits and risks of testing becomes available. Further discussions are also needed to take into account changes in the patient’s health, values, and preferences.