Prostate cancer, unlike other forms of cancer, often grows slowly.
That fact can make screening, treatment and potential outcomes seem a little less intimidating.
However, prostate cancer’s slow-growing tendency can obscure other, more complicated aspects of detection and treatment.
First, decisions on when to get screened and how to respond to the results are complex, based on many individual factors. And second, prostate cancer is not always slow-growing.
For those reasons, effective prostate cancer care and prevention rely on education and consultation — knowing the facts and working with experienced physicians to make the best decisions possible.
“There’s no clear recommendation for prostate cancer screening,” says Kevin S. Choe, MD, PhD, a board-certified radiation oncologist at the Inova Saville Cancer Screening and Prevention Center. “The emphasis has always been on having a shared decision-making process with the patient and the physician.”
Prostate Cancer: Key Facts and Risk Factors
Before delving deeply into the complex aspects of prostate cancer screening and treatment, let’s start with the basics:
- Other than non-melanoma skin cancer, prostate cancer is the most common cancer among men in the United States.
- It often develops late in life, and combined with its slow-growing (or indolent) nature, that means many men will die with prostate cancer, but not from prostate cancer.
- Prostate cancer still can be aggressive. It is still the No. 2 cancer killer among men in America, behind lung cancer.
- Age is the largest risk factor for prostate cancer.
- Family history also plays a role, as do genetic and hereditary factors such as Lynch Syndrome and BRCA gene defects.
- African American men are more frequently diagnosed with prostate cancer, and when they are, the cancer is more likely to be aggressive.
Prostate Cancer Screening Decisions
In general, men between the ages of 40 and 50 are advised to meet with their physician to discuss getting a prostate cancer screening. The exact age for this consultation depends on their risk factors.
And the guidance is to discuss screenings in that age range — not necessarily schedule a screening right away.
That’s one reason that Dr. Choe says it’s a complicated process.
Before scheduling a screening, he suggests meeting with a prostate cancer specialist or your physician to discuss the risks and benefits, as well as the potential next steps you would take depending on screening results.
Taking such a considered approach reduced the chances of receiving a false positive test and the unnecessary anxiety — and potential unnecessary medical procedures — that could come with such a result.
Prostate cancer screening is performed mainly through a prostate specific antigen (PSA) test. And there are benign processes that can elevate PSA levels.
“Just because your PSA level is high, you may worry that you may have cancer, and that may lead to a prostate biopsy, only to show there is no cancer,” says Dr. Choe.
When You Are Less Likely to Need Prostate Cancer Screening
Dr. Choe knows about the potential downsides of prostate cancer screening from personal experience.
When he was 40 years old, at the recommendation of a new primary care physician, he had a PSA test. It showed elevated levels.
What followed was a prostate biopsy that showed no evidence of malignancy, an MRI scan, genetic testing and an additional biopsy.
“During that six-month period, it … was a lot of turmoil,” he recalls. “Here I was, a young man just about to start a career, with young children, and the thought of being diagnosed with cancer — it definitely had a negative impact.”
None of the additional tests indicated he had prostate cancer.
“Thankfully I got away from all those procedures without major side effects,” says Dr. Choe. “But these procedures are not risk-free. They can cause permanent problems, albeit at a very low risk.”
His takeaway from that experience: A 40-year-old man with no family history of prostate cancer is unlikely to need a screening.
If Prostate Cancer Is Detected
While prostate cancer risks can be low enough in some cases that a physician might not even recommend screening, it’s also important to remember the other end of the risk spectrum: prostate cancer is not always slow-growing.
“What my patients are most surprised by when I discuss these things is the fact that prostate cancer is the No. 2 cancer killer among men in America,” says Dr. Choe. “We always talk about prostate cancer being so common, so indolent, that they don’t even need to get treated, but that’s not always the case.”
That variance is another reason that education and consultation are crucial for patients. When prostate cancer is detected, there could be a variety of treatment options, including no treatment at all.
“It’s even more critical (then) that you meet with an expert in the field to talk about various treatment options,” says Dr. Choe. “It’s not a simple process.”
Education and Guidance about Cancer Screening
The complex nature of prostate cancer screening, treatment and care is why the Inova Saville Cancer Screening and Prevention Center exists.
Patients get better results when they understand the risks, are presented with the best options and have expert caregivers to advise them.
“Meeting with a specialist who can guide you through this with a lot of experience and expertise (is) critical,” says Dr. Choe. “We consider all the risks and benefits and what the available options are.” The Center provides these services “so that (patients) don’t feel like they have to decipher through all of that on their own.”