Men urged to discuss prostate screening at 45

By Sharon N. Simon

sharon.simon@antiguaobserver.com

Men should discuss a prostate-specific antigen (PSA) blood test with their doctors around age 45, particularly if they face a higher risk of prostate cancer, Mayo Clinic urologic oncologist Dr Jack Andrews has urged during Prostate Cancer Awareness Month.

Andrews said the PSA test is inexpensive and non-invasive and can help detect cancer before symptoms develop. He said early detection could allow doctors to monitor a low-risk cancer or intervene when treatment is needed.

Prostate cancer is one of the most common cancers among men. Black men face a higher risk of the aggressive disease, Andrews said, and men with a family history should also discuss when to begin screening. He recommended considering a test 10 years before the age at which a close relative was diagnosed.

Dispelling a persistent fear, Andrews said screening does not necessarily require a digital rectal examination. A PSA blood test is generally the starting point, he explained. He also said lifestyle appeared to have little bearing on an individual’s risk and urged men not to assume their habits made testing unnecessary.

Andrews said approximately 99 per cent of men with early-stage prostate cancer have no symptoms, making screening important for early detection. Urinary problems in older men are often caused by benign prostatic hyperplasia, or an enlarged prostate, which is a separate, non-cancerous condition. Bone pain can be a sign of advanced disease, he said, although he said late-stage presentations were uncommon and cautioned against assuming that such symptoms meant cancer.

When a raised PSA level prompts further evaluation, a prostate MRI can help doctors decide whether a biopsy is needed. Findings may show no cancer, a low-risk cancer suitable for active surveillance or a cancer that requires treatment. Active surveillance can allow some men to defer treatment and its side effects for years without compromising long-term outcomes, Andrews said.

For patients who need treatment, surgery and radiotherapy can offer similar cure rates, Andrews said. He said the choice depends on factors including age and overall health and the potential side effects of each approach. Younger patients may recover better from surgery, while radiotherapy may be more suitable for some older patients or those with heart conditions or a history of abdominal surgery.

Andrews said advances in treatment over the past decade have also allowed many men with metastatic prostate cancer to live comfortably for years. He urged men not to let concerns about side effects, including erectile dysfunction or urinary incontinence, prevent them from seeking medical advice, saying “knowledge is power”.

Looking ahead, Andrews expects screening guidelines to become more consistent and treatment to become more personalised through advanced biomarkers. He said those developments could ease pressure on primary care providers and improve outcomes.

His message to families was to raise the subject of PSA screening with a doctor around age 45. He described that conversation as an important step men could take to protect their health.