To screen or not to screen… that is a thoughtful decision. Screening for prostate cancer should not be performed without an informed decision-making process. Most elderly men die with prostate cancer, not from it. The risk of screening is that prostate cancer (that may not impact quality of life or life expectancy) may be treated with painful and invasive procedures that may cause urinary incontinence and impotence for the rest of a man’s life.
Who? And when to screen? Men to screen have at least a 10-year life expectancy. Beginning at age 50 men with average risk should be informed about their screening options. Men with higher risk including blacks or men with a family history of prostate cancer before age 65 should be informed screening to begin at age 45. Men with multiple family members diagnosed with prostate cancer before age 65 should be informed beginning at age 40.
The test of choice? Prostate-specific antigen (PSA). This blood test can be performed with or without a rectal examination. Men with PSA less than 2.5mcg/L may be screened every 2 years, whereas those with 2.5-4.0 mcg/L should have annual testing. A PSA level above 4.0mcg/L should be offered referral to an urologist for further testing.
Hope this helps.