Prostate Cancer Screening Best Practice
An American man has a 16% lifetime risk of prostate cancer—not quite one in six.
Though the risk of dying of prostate cancer is only 2.9 percent, it’s still the second leading cause of cancer death among American men, after lung cancer.
So there’s recent concern about significant declines in:
- The number of men taking the once-standard prostate specific antigen (PSA) test
- The number of positive diagnoses made
- The number of interventions prescribed
The American Cancer Society, for example, found that in 2013, 31 percent of U.S. men over 50 had a PSA test, down from 38 percent in 2010. (A PSA test is looking for the presence in the blood of a specific protein produced by the prostate gland. High levels of the protein may indicate a prostate abnormality.)
At the same time, diagnoses of prostate cancer declined from 213,000 in 2011 to 180,000 in 2012.
Fewer cases diagnosed is good news, no?
To PSA or not to PSA
The PSA test—the go-to diagnostic tool since the mid-1980s, is no longer routinely recommended for healthy men of all ages. In 2012, the US Preventive Services Task Force (USPSTF) officially recommended against that.
It was a very controversial call.
Some doctors agreed with it; the PSA test often missed cancers that were there, or found cancers that weren’t. False positives too often led to unnecessary biopsies—a dangerous, painful, hit-or-miss procedure—and unnecessary surgeries, chemo, or radiation therapies.
Some doctors disagreed, claiming that without the PSA test, too many real cancers would never be detected, driving the risk of death higher.
Both sides are right, but both are wrong.
Why continue getting the PSA test?
I still believe the PSA test is useful—but only over time. You shouldn’t rely on any single test result as a yes/no decision maker. This is where conventional medicine dangerously missed and still misses the point.
With the PSA test, what you need is a benchmark. Not the conventional one-off “Your PSA is over 4.0, so we need a biopsy.”
Get your first PSA test for a benchmark. It’s simple: just need a blood sample.
No matter what the result, get another test in a year or two. If there’s not much change and no troubling symptoms? Another test a year or even two years later.
I know—doing nothing for that long sounds risky.
But we now know that prostate cancer progresses very slowly. Men are more likely to die with it, from other causes, than from it.
So watch for significant change in PSA results, one test to the next. What’s a significant change? If you’re older than 40, and your PSA results move up or down 50% or more.
But a biopsy is not necessarily the next step.
New tests get it right
After signification PSA result change, ask your doctor for the prostate cancer gene3 (PCA3 ) test. It requires nothing more than a urine test that looks for active genes that are found only in prostate cancer cells. Most insurance will cover this test based on elevated PSA results.
It’s been available since 2004, but few physicians use it. You might need to enlighten your doctor about it.
You can trust the PCA3 test because in 95 percent of diagnosed prostate cancer cases, the PCA3 gene is highly visible. So when if you have it, it’s time for another test.
This one is the Color Doppler Ultrasound exam. It’s non-invasive, painless, and takes about 30 minutes. It shows prostate tumors—even the type, location, and stage—and other abnormalities.
If test results are inconclusive, or there’s a typically slow growing cancer, “watchful waiting” is the recommendation.
But waiting in medical talk means no surgery or medication, not no action.
Reduce your risk
Gentlemen, please—use the time between exams to improve your overall health.
In one study, eating 10 or more servings of tomato-rich foods a week reduced prostate cancer rates by 45 percent, and 4 to 7 servings resulted in a 20 percent reduction.
Tomatoes are rich in a powerful, anti-prostate-cancer, antioxidant carotenoid called lycopene. Cooked tomatoes (and tomato sauce) actually bring out more lycopene than uncooked, but all tomatoes have it.
Tomatoes are found in abundance in the Mediterranean diet—also part of my prescription.
And of course exercise, even if it’s only a walk around the block.
Most important: if you’re worried about prostate cancer, don’t delay or deny. Get a PSA test. Use it as a benchmark, wait a year, and get another PSA. test. If there’s a 50% or more change up or down, make sure your doc agrees to use the PCA3 and Color Doppler diagnostic tools. And don’t even think about a biopsy unless ALL tests indicate cancer.
- Prostate-Specific Antigen Screening After 2012 US Preventive Services Task Force Recommendations. 2015;314(19):2077-2079. doi:10.1001/jama.2015.7273.
- Original Investigation Prostate Cancer Incidence and PSA Testing Patterns in Relation to USPSTF Screening Recommendations. 2015;314(19):2054-2061. doi:10.1001/jama.2015.14905.
- Norton A. Prostate Cancer Screening, Detection Both Down In U.S., Studies Say. http://www.pcf.org/site/c.leJRIROrEpH/b.9351447/k.E2A7/Prostate_Cancer_Screening_Detection_Both_Down_in_US_Studies_Say.htm
- Kilpeläinen, T., Tammela, T., Määttänen, L., Kujala, P., Stenman, U., Ala-Opas, M., Murtola, T., & Auvinen, A. (2010). False-positive screening results in the Finnish prostate cancer screening trial British Journal of Cancer DOI: 10.1038/sj.bjc.6605512
- Moyer VA on behalf of the U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine 2012; 157(2):120–134. [PubMed Abstract]
- Prostate-Specific Antigen (PSA) Test. http://www.cancer.gov/types/prostate/psa-fact-sheet#q1
- Ries, LAG, Melbert, D, Krapcho, M, et al (Eds). SEER Cancer Statistics Review, 1975-2004, National Cancer Institute, Bethesda, MD 2007. Available at: http://seer.cancer.gov/csr/1975_2004/ (Accessed on October 16, 2009).
Last Updated: May 13, 2019
Originally Published: January 27, 2016