Approximately one in eight men will be diagnosed with prostate cancer in their lifetime, and the majority of these diagnoses are in men who are older than 65. Early diagnosis is key to survival. When found in an early, localized stage, prostate cancer has a five-year survival rate of more than 99%.
Screening Guidelines and Shared Decision-Making
Recommendations and protocols for prostate cancer screening and treatment have evolved as the medical community learns from research, clinical practice, and shared knowledge. Changes in recommendations can create confusion for individuals making health decisions. To support decision-making, here are updates on screening and treatment guidelines.
Prostate Cancer Screening Protocol
In general, health screenings are an important part of preventive care because they can detect problems in the earliest, most treatable stages. This is true for prostate cancer, where screenings such as a prostate-specific antigen (PSA) blood test can detect early-stage, slow-growing prostate cancer. Sometimes, these slow-growing cancers never affect a person’s health.
PSA testing can yield false positive results, especially in older men, which may lead to unnecessary worry and biopsies. Biopsies can be unnecessary and carry risks such as pain or infection.
Therefore, both the American Cancer Society and the U.S. Preventive Services Task Force (USPSTF) recommend that men between age 55 and 69 with average risk discuss the benefits and risks of screening with their primary care provider (PCP) and make an individualized decision. Men aged 70 and older should talk with their PCP to decide whether screening should continue.
Concerning Symptoms to Discuss with Your PCP
Talk to your PCP if you are experiencing symptoms such as:
- Blood in the urine or semen
- Painful ejaculation
- Pain in the back, hips, or pelvis that does not go away
- Pain or burning during urination
- Weak or interrupted urine flow
Watchful Waiting for Low-Risk Cancer
Over the past 10 to 15 years, the standard practice for slow-growing, early-stage, low-risk prostate cancer has shifted toward active surveillance, which involves close observation and monitoring over time. This approach avoids immediate treatment when the cancer is unlikely to spread or affect health.
Under active surveillance, patients typically have regular visits with a urologist, including PSA testing and digital rectal exams, to monitor for signs of progression.
Active Surveillance Initiatives in Michigan
In Michigan, Blue Cross Blue Shield of Michigan and urologists across the state are collaborating to collect data and guide decisions about which patients should consider active surveillance. The MUSIC AS initiative has helped clinicians develop a roadmap for selecting appropriate candidates and managing the surveillance process. Patient guidelines have been created to outline a clear schedule and process for active surveillance in an accessible format.
Conclusion
Decisions about prostate cancer screening and treatment are personal and depend on individual health history and circumstances. Thoroughly discuss risks and benefits with your PCP before making a decision.
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