Tennessee’s males have higher prostate cancer rates than the national average. But does that mean you need to run out and get screened for prostate cancer right away?

WellTuned spoke with Dr. Ian Bushell, a medical director with BlueCross BlueShield of Tennessee, to learn more about prostate cancer screenings and who might need to prioritize getting screened and when.

Prostate cancer by the numbers

Prostate cancer is the second leading cause of cancer-related deaths in males. Experts predict that about 34,700 people in the U.S. will die from prostate cancer in 2023.

Dr. Bushell: While prostate cancer kills some people, the vast majority die with prostate cancer not because they have prostate cancer. Males are much more likely to develop prostate cancer than they are likely to die from prostate cancer.

Consider the survival rates. For the most part, survival rates are very high, according to the American Cancer Society. Survival rates for prostate cancer diagnoses in the U.S. are based on how far the cancer has spread vs. grouping it by stages (stage 1, stage 2, etc.):

• Localized: There is no sign that the cancer has spread outside the prostate.
• Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
• Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.

For localized cancers, the 5-year survival rate is 100%. And it only dips to 99% for cancers that have spread to nearby tissues and lymph nodes. It isn’t until prostate cancer is diagnosed when it has already spread to distant parts of the body that the 5-year-survival rate drops to 33%. However, less than 10% of cases are distant cases.

The effect of evolving screening recommendations

Dr. Bushell: You may not necessarily need to get screened for prostate cancer right now. Prostate cancer screening recommendations are a complicated topic that has evolved over the years. It’s important to know that the benefits of screening a population for prostate cancer aren’t completely proven yet.

Also, different organizations have conflicting screening recommendations. So, it’s important to make sure you’re up to speed on the various current guidelines. In fact, the US Preventive Services Task Force (USPSTF) which generates screening recommendations for physicians has repeatedly recommended against screening men for prostate cancer. Only recently has the USPSTF stated that men aged 55-69 should discuss it with their physicians.

Currently, the American Cancer Society recommends that males have a conversation with their doctors about whether or not they should be screened for prostate cancer. Generally, they recommend screenings in the following situations:

• At age 50, if you’re at average risk and expect to live for at least another decade
• At age 45 if you’re at high risk, which includes having a brother or father who had prostate cancer before they turned 65
• Age 40 if you’re at especially high risk—that is, you have more than one first degree relative who had prostate cancer when they were younger than 65.

Essentially, if you know you’re at high risk, per the American Cancer Society, it may be time to broach the subject with your doctor and figure out the right timing for a screening. African American males are also statistically at higher risk than other males, so that may also factor into your doctor’s assessment of when you need to be screened.

Screening options available to you

Dr. Bushell: If your doctor agrees you’re a good candidate for a screening, they’ll likely do a rectal exam and order a blood test. The blood test is a prostate-specific antigen (PSA) test and measures the amount of a prostate-specific antigen in your blood. The levels of this antigen can vary, but generally, you can expect your level to increase as you age. For that reason, the level that’s considered “abnormal” is lower for younger men than for older men. Note: your level can also be elevated for many other reasons that are not cancer.

However, some experts caution that this test can lead to overdiagnosis and overtreatment. The reason is that this test can pick up small, slow-growing tumors that are unlikely to be life-threatening. In fact, the PSA test was not developed to be a screening tool but has been widely used as one. Physicians are now trying to slow down the use and be more precise about testing only the appropriate patients.

This may be something to consider discussing with your doctor when you discuss screening.

Also, if you’ve already celebrated your 70^th birthday, your doctor may not advise getting a PSA test. The USPSTF does not recommend that people over 70 undergo PSA screening.

If you do undergo a PSA test and get an elevated result, your provider will likely repeat the test, possibly several times. They may also recommend other labs or imaging tests to further assess your risk.

“As a primary care physician, I’m a strong advocate for early detection and prevention of disease,” says Dr. Bushell. “Unfortunately, regarding prostate cancer, screening for it is the total opposite of a ‘no brainer.’ I encourage men who are interested in screening for prostate cancer to speak with their healthcare providers so they can make a recommendation that best matches their specific situation and risk factors.”

More from Dr. Ian Bushell on WellTuned.

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