Prostate Cancer Screening Can Save Your Life
By Richard Augspurger, M.D., F.A.C.S., The Urology Center of Colorado, E. Denver LIVING WELL Magazine
As we struggle through the hot, dog days of summer and approach September, we come to National Prostate Cancer Awareness Month. Many men are not aware of what a prostate cancer screening entails or when they should be screened. The Urology Center of Colorado’s (TUCC) recommendations follow the recommendations of the American Urological Association’s Best Practice Statement of 2009 and the National Comprehensive Cancer Network. If a patient has a life expectancy greater than 10 years, he should have a baseline DRE (digital rectal exam) and PSA (prostate specific antigen) at age 40. Follow-up screening depends on many factors including the initial PSA level, family history, race, life expectancy and the patient’s desire to be screened.
PSA ≥1 (or ≥0.6-AUA) – Yearly PSA and DRE
PSA <1 (or <0.6-AUA) – Repeat at age 45
Family History of Prostate Cancer or African-American
Yearly PSA and DRE
Biopsy is indicated if the patient has:
- Abnormal DRE
- PSA >10
- PSA 4-10, prefer biopsy
- PSA between 2.6-4 or ≤2.5, If PSA increases over one year ≥0.35
More than 3,000 Colorado men will be diagnosed with prostate cancer this year. Thanks to annual screenings, the death rate from prostate cancer has declined 30%. During the first decade of my practice, urologists did not have PSA as a screening tool. The only way to detect prostate cancer was through a DRE. At that point, 35% of men diagnosed had cancer that had already spread outside of their prostate (metastasized) and 67% had locally advanced disease, which is very difficult to cure. Today, through PSA and DRE screening, only 20% of men are diagnosed with locally advanced or metastatic disease.
Seventeen percent of men will be diagnosed with prostate cancer, but only 3% of these men will die from prostate cancer. As you can see, a prostate cancer diagnosis is common, but dying from prostate cancer is uncommon. The controversy surrounding prostate cancer screening is a result of the difference between the number of men who have prostate cancer and number who will die from prostate cancer. There are many factors that contribute to determining if an individual’s prostate cancer is a “good” cancer or a “bad” cancer. These factors are based on the results of the biopsy, lab studies and radiology reports. One factor that is important in curing prostate cancer is how early you detect the cancer. Is it locally confined or advanced disease? If you do not screen for prostate cancer and biopsy the prostate when indicated, you will delay the cancer diagnosis. I believe it is better to know if you have cancer and how aggressive that cancer is. Then you can discuss appropriate treatment with your urologist, which may include no treatment.
If you have any questions about being screened for prostate cancer, I encourage you to talk it over with your primary care physician or with a urologist at TUCC. Visit www.tucc.com or call 303-825-TUCC (8822) for more information.