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My Doctor Doesn’t Recommend PSA Screening for Me. Is That Safe?

Highlights:

  • American Urological Association has updated its recommendations on routine prostate cancer screening.
  • Low-risk men aged 40-54 are not advised to get routine PSA blood tests.
  • Medical experts say routine PSA screening often leads to unnecessary procedures and treatments.
  • Each patient should weigh the pros and cons of testing and get advice from his doctor.
  • Men with a family history of certain cancers might benefit from genetic screening.
  • Prostate problems and treatments may cause erectile dysfunction.

 

“You don’t need to get tested for prostate cancer.” Wait, what?

Many men seeing their doctors for regular checkups are surprised to hear doctors advising them against PSA screening. Aren’t PSA tests supposed to be a good thing?

When it comes to your health, you’re trying to do the right thing. You eat healthy — save for that occasional steak. You run three times a week. You quit smoking long ago and drink in moderation. You get regular checkups. And now, you are supposed to give up on a simple test that could detect a life-threatening condition?

It turns out routine PSA screening can do more harm than good. Read on to learn more about potential risks of prostate cancer testing and what to do to stay healthy.

Blood tests to detect prostate cancer risks are not routinely recommended anymore
Blood tests to detect prostate cancer risk are not routinely recommended anymore.

New Recommendations on Prostate Cancer Screening

PSA screening is a way to detect prostate cancer.  All you need is a simple blood draw that will tell the doctor how much prostate-specific antigen (PSA) is in your system.

Medical experts used to recommend routine PSA screening for all men above the age of 40. This has changed in recent years. Here is what the guidelines of the American Urological Association (AUA) currently say about early prostate cancer detection:

  • Men who are between 40 and 54 and at an average risk are not recommended to get routine PSA screening. Men at a higher risk should make their own decisions based on the recommendations of their doctor.
  • Men between 55 and 69 may choose to receive regular PSA testing. They should make an informed decision based on what their doctor suggests, their medical history, and personal preferences. Should the patient decide to get screening, he may get tested annually or every two years. The second option reduces the risk of overdiagnosis.
  • Men who are older than 70 don’t need routine PSA screening. Experts explain that the average life expectancy at this age is 10 to 15 years. Since prostate cancer tends to grow very slowly, it is much more likely that the man will die of other health problems or of natural causes.

Why Are PSA Tests Not Widely Recommended?

PSA screening sounds like an ideal preventive solution – it’s noninvasive and inexpensive. Why then, have medical experts deemed it as not appropriate for routine use?

  • PSA tests are not reliable enough. According to one study conducted in Europe, approximately 20 percent of tests end in false positives. There are multiple factors that can cause faulty results, including a urinary tract infection.
  • PSA screening leads to more invasive procedures. Blood results are often inconclusive, and doctors decide to order more testing to check for cancer. The most common procedure is a prostate biopsy.Besides pain and stress, this type of screening is linked to a high risk of complications. A 2011 study by Johns Hopkins researchers revealed that almost 7 percent of men who had a prostate biopsy needed hospitalization within a month.
Biopsy patients often require hospitalization
Prostate biopsy patients often require hospitalization following the procedure

To Treat or Not To Treat?

When screening does reveal that a patient has cancer, he and his doctor are faced with the treatment decision. While a traditional approach would include more invasive options, research now suggests that observation with careful monitoring might be more beneficial for low-risk patients.

  • Overdiagnosis leads to unnecessary treatments. A common course of action for prostate cancer is surgical removal of the prostate. The procedure is costly and comes with side effects, from bleeding to erectile dysfunction.
  • Prostate cancer grows slowly. Many men with prostate cancer go through life without even knowing they have it. Overdiagnosis and subsequent surgeries lead to unnecessary loss of quality of life and sexual satisfaction in many patients.
  • Active surveillance is often a better choice. Patients diagnosed with low-risk prostate cancer may be given a choice of active surveillance. (Recent studies, such as this one, are finding that it may be the right choice for some men with intermediate-risk cancer as well.) With active surveillance, doctors won’t take invasive steps and will regularly observe cancerous tissue. It may still be necessary to take a more radical route but only if test results suggest the disease is becoming more aggressive.

Should I Have Genetic Testing for Prostate Cancer?

If you are under 55, it’s reasonable to be confused about the new recommendations. Should you just sit and wait, hoping for the best? Are there any other tests you can do to assess your risk?

These are the questions you should be asking your doctor at health checkups. Make sure to talk about genetic factors. According to a 2019 cross-sectional study of over 3600 men with prostate cancer, in 17 percent of cases, the disease was caused by an inherited genetic mutation.

Men with a family history of certain cancers might benefit from genetic screening to find out if they are in the high-risk group. If someone in your immediate family had prostate, breast, ovarian, or colon cancer, tell your doctor about it.

Some men may benefit from genetic testing for prostate cancer
Some men may benefit from genetic testing for prostate cancer

What Can I Do to Prevent Prostate Cancer?

Is there any way to reduce the risk of prostate cancer? Unfortunately, there is not much you can do. A meta-analysis of 14 studies revealed that vitamin or mineral supplements are not effective in lowering your prostate cancer risk.

General recommendations for prostate cancer prevention are to:

  • Maintain a healthy weight, especially by limiting the amount of fat from red meat and dairy, and eating more fish.
  • Avoid consuming more than 1,200 mg calcium per day.
  • Quit smoking and limit alcohol.
  • Manage your stress levels.

Dealing With Prostate-Related ED

Prostate problems lead to many unpleasant consequences, including in the bedroom. Even non-cancerous enlargement of the prostate gland, called benign prostatic hyperplasia, could be linked to erectile dysfunction.

Prostate cancer treatments — especially surgical interventions — have ED as a common side effect.  In fact, almost all men who have a radical prostatectomy develop erectile dysfunction, and all lose the ability to ejaculate (though many can still have orgasms).

Luckily, modern ED treatments, such as Viagra, Levitra, or Cialis, are effective in treating post-prostatectomy ED. Talk to your doctor about options and click here to order your medication online at eDrugstore.com, a reliable online pharmacy where virtual health visits and shipping are always free.

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