The recommendations for screening for prostate cancer have been in the news a lot lately. One view calls for annual prostate specific antigen (PSA) screening as early as age 40 while another suggests that we should not be screening PSA at all.
Just as changes in the recommendations for breast cancer screening left many women unsure about how to proceed, these new prostate cancer screening guidelines can leave men with confusion about what option is best for them.
Some men may visit a urologist with a referral from their primary care physician due to an elevated PSA level, abnormal PSA trend, or a concerning prostate exam. As a urologist, my approach is to work with patients to help them understand the entire process of screening for prostate cancer with an emphasis on education. Patients should be involved in the decision-making process and discussion that leads up to screening.
Prostate Cancer Screening
Screening involves measuring your blood levels of PSA, a protein that is produced by cells in the prostate gland. An elevated level of PSA could be an indicator of prostate cancer, but could also be related to non-cancerous conditions. After a PSA screening, a urologist may recommend a biopsy or proceed with further observation. A biopsy is a short office procedure, taking less than five minutes and yields results in about a week. If the biopsy returns with a negative result, you may continue with screening. If you have a positive prostate cancer result, your urologist will begin by explaining what was found and what risk the type of cancer poses.
Multidisciplinary Team Approach
If a cancer has been confirmed on biopsy, an approach we use in our practice is to offer patients the option of taking part in a multidisciplinary team appointment that involves a group of medical professionals coming together to learn about a patient's case and then discussing that case before making a recommendation. The multidisciplinary approach includes input from a urologist, medical oncologist, radiation oncologist, social worker, physical therapist and nurse. This approach puts patients at the center of the discussion and includes them as part of the team.
Patient Navigator
Navigating a cancer diagnosis that has multiple treatment options can be an overwhelming task. In our clinic, the person who helps you through that maze, from diagnosis to decision making to treatment, is the Patient Navigator. Patients can rely on this navigator through every step of the process when they have questions, concerns or need help arranging appointments.
The multidisciplinary approach takes into account that different patients are candidates for different treatment modalities. Some may be appropriate for radiation and not surgery or vice versa. Others are appropriate for observation (called active surveillance) and can continue to lead lives that are not affected by their prostate cancer diagnosis. During this education process, it is important to help the patient understand the benefits and possible side effects of each treatment strategy. It is not a mystery that the goal of prostate cancer surgery or radiation is a cure, but this can come at a cost as these treatments have the potential to cause lifestyle changes such as urinary changes or erectile dysfunction. Current selective techniques in radiation and advances in surgery can decrease the rates or duration of these side effects. As patients gain knowledge, it is critical these concepts are related so an appropriate treatment option is chosen.
We do know that the rate of prostate cancer death has decreased over the past two decades. While many urologists believe this is tied to use of PSA screening, other organizations feel that PSA screening has had little impact on the rate of prostate cancer deaths. With no definitive conclusion about PSA screening at this time, I recommend working with your primary care physician and urologist to educate yourself as this will help you make the decision that is best for you.
For more information please call 603-658-1277.