Empowering the Patient: New Directions in Prostate Cancer Guidelines
Key Takeaways:
- The latest guidelines from the American Cancer Society shift the decision of prostate-specific antigen (PSA) testing to patients; recommending patient-doctor discussions to evaluate the appropriateness of such tests.
- PSA tests, although able to detect cancers, also uncover cancers that may not be harmful in a man’s lifetime. This could lead to unnecessary treatments and undesirable side effects like urinary incontinence and impotence.
- Men in good health, without any symptoms and expected to live at least another 10 years should start discussing prostate cancer screening after turning 50. Those at high risk, like black men and those with a family history of prostate cancer, should start these discussions earlier.
- Deciding on PSA testing should involve a comprehensive evaluation of a patient’s life expectancy. It might be suitable for men expected to live 15 years or more, or reasonably healthy men in their 40s or 50s, but not for elderly patients with significant health problems.
- Prostate cancer is the most common type of cancer in American men, after skin cancer, with over 192,000 new cases diagnosed annually and nearly 27,400 men dying from the disease each year. However, the death rate is steadily declining.
The latest guidelines on prostate cancer screening issued by the American Cancer Society pushes the mantle of decision-making onto patients. These new recommendations take a step back from routine prostate-specific antigen (PSA) testing, stressing instead on the importance of patient-doctor discussions to evaluate the suitability of such tests on a case-by-case basis.
The Controversy of PSA Testing
PSA tests, which measure levels of prostate-specific antigen produced by the prostate gland, do detect cancers. However, they can also uncover malignancies that may never cause any harm during a man’s lifetime, leading to unnecessary treatments and undesirable side effects, such as urinary incontinence and impotence.
The new guidelines acknowledge the uncertainties surrounding PSA tests, which have been controversial for some time due to conflicting results from various studies about the screening’s value.
A Personal Perspective: Dr. Len Lichtenfeld
Even medical professionals, like Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, have found themselves conflicted about the value of repeated tests when his usually consistent PSA levels experienced a significant increase. Following a period of anxiety and delay, he discovered his PSA levels returned to baseline, saving him from confronting further decisions about seeking treatment and the type of therapies to follow.
Screening Recommendations & Dialogue
Guidelines posted by the American Cancer Society suggest that symptom-free men in good health, expected to live at least another 10 years should make an informed decision about prostate cancer screening after weighing the uncertainties, risks, and potential benefits. This discussion should start when a man turns 50. Men who aren’t expected to live more than ten years due to age or poor health should not be offered prostate cancer screening.
The society advises men at high risk of prostate cancer, such as black men and those with a family history of prostate cancer, to start these dialogues earlier. If a man is still unable to decide, the physician, based on their knowledge of the patient’s health preferences and values, should make the screening decision.
Considerations for Doctors
Guidance for patient care demands that doctors consider a man’s total medical profile, despite the often pressing factor of time. However, as Dr. Lichtenfeld acknowledges, this integral conversation must occur, even in the reality of time-pressured practice. It facilitates honesty about what is and isn’t known.
Evaluating Life Expectancy and Patient Suitability
Deciding whether to perform a PSA test necessitates a thorough look at a patient’s life expectancy, according to Dr. Basir Tareen of Beth Israel Medical Center. For instance, a patient expected to live 15 years or more may benefit from PSA screening, while an elderly patient with multiple health problems may not be a suitable candidate.
For reasonably healthy men in their 40s or 50s, it’s reasonable to obtain a baseline PSA level, then discuss whether to continue regular testing.
Raising Awareness: Prostate Cancer Figures
As per the American Cancer Society, more than 192,000 new cases of prostate cancer are diagnosed annually in the United States, and nearly 27,400 men die from the disease each year. It’s the most common type of cancer in American men, after skin cancer, and the second leading cause of cancer death in men. One in six men will develop prostate cancer during his lifetime, and one in 35 will die from it. Over 2 million men in the United States who’ve had prostate cancer continue to live, and the death rate is steadily declining.
Continual Revisions in Cancer Screening Advice
The new prostate cancer guidelines mark the third time in four months that medical experts have offered new insights on cancer screenings, reflecting the ongoing examination and evolution of medical practices. The proposed changes continue to evoke robust discussion and reiterated the need for personalized patient-doctor dialogues.
More information
The American Cancer Society offers more information on prostate cancer.
