What is new with Prostate Cancer Screenings?

Samuel B. Kieley, MD, Urologic Oncology
In 2020 prostate cancer was the most common cancer diagnosis and second leading cause of cancer death among American men with approximately 190,000 new diagnoses and over 33,000 deaths. This equates to a 1 in 9 lifetime risk of getting prostate cancer and a 1 in 40 risk of dying from it. Fortunately, the risk of death has declined between 1993 and 2016 by 51% thanks to screening for prostate cancer.

Prostate cancer screening includes both a prostate exam and a PSA blood test. The combination of these two tests offers improved diagnostic accuracy compared to either alone. The current guidelines recommend screening to begin after a discussion of the risks and benefits with your primary care physician or urologist. The age to start screening is 45 for most men, but those with a family history, genetic predisposition or African ancestry should start at age 40. Screening should continue every 1-2 years until age 75, or older in select patients. If an abnormality is noted, then an MRI is often ordered. By using MRI, patients are able to avoid prostate biopsy almost 30% of the time and to improve diagnostic accuracy if the biopsy is needed.

Treatment of prostate cancer varies between active surveillance (monitoring the cancer), radiation, surgery and systemic treatment. In general, the treatment options are based on the pre-treatment risk stratification. For most men with very low and low risk cancer active surveillance is the preferred option. If treatment is required, then using the latest techniques in radiation therapy or robotic surgery help to maximize the benefit and reduce the risk. Many new systemic therapies are available to help men with disease that has advanced to the lymph nodes and bones. One key to these advancements has been the progression of genetic testing and the ability to proceed with more targeted therapy. Another development has been the FDA approval of the PSMA PET scan which allows for very accurate imaging of advanced prostate cancer. This test can be beneficial in men with advanced or recurrent prostate cancer.

We have made progress with prostate cancer screening, staging and treatment. The most important part of the process is a commitment to start screening. In September, we are glad to celebrate prostate cancer awareness month as a chance to raise awareness and start a discussion about this common and treatable disease.
Dr. Sam Kieley is a highly respected Urologic Oncologist and a speaker on the topic of prostate cancer prevention and treatment he can be reached at 805.349.7133.