PROSTATE CANCER: When Should I Start and Stop PSA Screening?
PSA SCREENING FOR PROSTATE CANCER
Is Age Truly The Answer?
I have never heard of a golf tournament or post-football party, where a group of men got together to discuss their health issues. Discussing the stage of their Prostate Cancer when they were diagnosed, the reason they chose the treatment they did (surgery vs Radiation Therapy vs active surveillance) and the side effects they experienced from their treatments. During my seminars in the community, it was no surprise that many did not know the ribbon color, or the month selected as “Prostate Cancer Awareness” month.
Men need to talk about their HEALTH issues and visit their physicians more often…and it is just not happening.
So what’s the fuss? What’s the big deal?
Men – your brother, husband, uncle, boyfriend, grandpa, cousins, friends – are dying needlessly from this disease. Prostate cancer is the second leading of cause of death in men in the United States. So what can you do to make a difference? There are a few things you should know.
The U.S. Preventive Services Task Force (USPSTF) set forth recommendations in 2018 that is affecting the way Primary Care Providers (PCP) handle PSA screening in men. Did you know that;
- PSA screening is recommended for men age 55-69?
- If you are age 70 or older, PSA screening is not recommended? It is actually given a grade “D” by the USPSTF
- Your actual overall health is not taken into consideration (based on statistics)?
- No mention of screening age for those of African Descent (Blacks/African American)? May consider earlier – given race is a “risk factor”
What Should I do?
Get your PSA with your annual exam as a basic “I should know” gift to yourself.
The USPSTF screening recommendation is a great disservice to men, and especially to the men in the African American/Black communities who are at a higher risk for the more aggressive type/stage of Prostate Cancer. I have seen many patients with high risk prostate cancer who:
- Had no “symptoms” – some had abnormal digital rectal exam (DRE) with PSA’s in the “normal” range
- Others had high PSA’s and normal DRE’s…but
- One thing remained constant – majority had NO symptoms that would be considered indicative of Prostate Cancer
Are they assuming the population at large knows the difference between signs vs symptoms?
- Sign = abnormal DRE, high PSA, etc., things a doctor can detect;
- Symptoms = changes in urination, etc., things a patient detect and tells the doctor
If you are experiencing symptoms and diagnosed with prostate cancer, then chances are it is in the more advance stage.
For the sake of clarification, the article did go on to say that PSA testing in males over 70 years old is a Grade D = inappropriate.
What say you?
The Truth To Tackle?
It is true, that Prostate Cancer can be a slow, indolent disease. for some men. Are you one of them?
It is true, that the treatments for Prostate Cancer has side effects that must be taken into consideration.
It is true, that some males over the age of 70 would not benefit from any treatment, either because they will die from some other disease process (such as Cardiac Infarction/Heart attack) or they have many other comorbidities (illnesses) that are more life threatening than Prostate Cancer.
It is also true, that symptoms for Prostate Cancer are very rare and therefore cannot and should not be used as a marker for testing.
It is also true, that age, race and family history plays a large role in Prostate Cancer screening, and
It is also true, that most treatments for Prostate Cancer has improved over the years with a decrease in much popularized side effects; albeit, the side effect of most concern, erectile dysfunction (ED), will occur with increase in age, with or without treatments.
When Should I Be Concerned About My PSA?
The USPSTF meant well and did a great job in presenting their PSA screening recommendations. However, a blanket statement as that presented, inadvertently makes PCP job more difficult, because they are steering away patients that would benefit most from treatments. Quite a few “low percentage” numbers are used in the article. But I tell you the truth, statistics becomes inconsequential, when the number is ONE and that number is YOU.
The decision of when to stop testing for Prostate Cancer, is not just an age/number, it should include the patient overall well being, and their desire and concerns should be taken into consideration. Therefore, I opine that the decision to stop testing for Prostate Cancer should occur during a conversation between a patient and his physician….be it at 60, 70, 80, or 90 years of age. Some men are just in stellar health! If, I have one more person in my FB Group upset, because they have metastatic prostate cancer at age 76, because they stopped checking PSA too soon … I will scream. Oh yes I will!
Next Step …
Now that you know more, speak with your physician to know what’s best for you. Tell your family and friends to do the same – spread the word! Think about the above seriously for all men. You could be saving a life – maybe your own!
Journal and Guide for Your Prostate Cancer Appointments
Until next time know that,
Life is beautiful and God is awesome. And know, you are pure awesomeness!
Ipsa Scientia Potestas est ——— Knowledge itself is power!
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Queen, Your Family Friendly Cancer Doc!