10 Nov Prostate Cancer screening still Controversial

Screeing for prostate cancer has been controversial but the the fact is that the incidence of Prostate Cancer presenting as metastatic disease has declined 50% since 1988, suggesting that PSA’s have effectively identified prostate tumors destined to present as metastatic disease.

I continue to encourage my patients  who are at average risk to have annual screenig done after the age of 50, if they are expected to live another 10 years.  If they are at high risk then start screening at the age of 45.  This would include African American men and men who have a first-degree relative that was diagnosed with prostate cancer at an age younger than 65.  Screening should start at 40 if more than one first degree relative was diagnosed at an early age.

PSA is the preferred method for screening, and a Digital rectal exam may be added.

If the PSA was <2.5 and no other evidence of cancer is seen, it may be acceptable to test every other year instead of annually.

NEJM 2015 Oct 29