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When and why you should get screened for prostate cancer

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This year, the American Cancer Society (ACS) estimates there will be just under 300,000 cases of prostate cancer and more than 35,000 deaths caused by it. After skin cancer, prostate cancer is the most common cancer among men, according to the ACS. While many men diagnosed never experience symptoms or need treatment, advanced cases can lead to death. Like any cancer, early detection is critical to beating the disease. But when should you get screened?

, a urologic oncologist at MedStar Georgetown Cancer Institute at MedStar Washington Hospital Center, said there are two categories.

“There is a category of higher risk in terms of potential future prostate cancer development,” Dr. Hwang said. “Those are men with positive family history of prostate cancer or breast cancer – especially if they have any loved ones who either passed away from either cancers or had metastasis (the spread of cancer) and ended up receiving systemic treatment.”

Men who have a family history should consider getting screened as early as age 40. African American men are two to three times more likely to die from prostate cancer than white men. Because of this, it’s recommended they start screening at age 45. Obesity and smoking are also considered risk factors. Those who have no symptoms and no risk factors should start screening at age 55.

A prostate-specific antigen (PSA) test is a blood test that can quickly screen for prostate cancer, especially if you have risk factors. It can be completed in your primary care provider’s office or at a local lab and you don’t need to fast prior to it.

If you have an elevated PSA level, you should follow up with your primary care physician. Although many men see elevated PSA levels, not all require treatment.

While acknowledging why men historically have shied away from screenings, Dr. Hwang said methods in which doctors screen for prostate cancer have become much easier.

“I think men in general are very afraid to undergo prostate cancer screening because of the historical nature of the screening method, which includes a digital examination, as well as a biopsy through the rectum, known as a transrectal biopsy,” he said.

Now Dr. Hwang said there’s a variety of non-invasive tools used to determine who needs a biopsy or not.

“We have dramatically cut down the number of men needing a biopsy by using these non-invasive methods, – about 1.3 million patients per year to less than 500,000.”

As for treating prostate cancer, Dr. Hwang said no matter what options are available, patients are better off when the cancer is caught in its early stages.

”When men present with more advanced or higher volume, more aggressive cancer, you often need to use multimodality treatment. That’s when not only cancer outcomes suffer – often significant side effects will occur – whether that is their bladder function, sexual function, or bowel function.”

Surgical treatment options are seeing advancements with robotic-assisted technology offering a minimally-invasive approach.

“Within the surgical arena, we’re developing a more refined robotic system that allows a surgeon to precisely remove the prostate with minimal collateral damage to the surrounding nerve tissue and the urinary sphincter muscles, which allow men to recover those functionality much quicker,” Dr. Hwang said.

Focal therapy is also now offered for men in the very early stages of prostate cancer. This method uses a high intensity focused ultrasound to ablate (remove) and destroy the cancer lesion while keeping the entire prostate gland intact.

There is also an advanced way of delivering radiation to treat the prostate while sparing surrounding tissue and allowing for an easier recovery.

Although there is improvement in treating prostate cancer Dr. Hwang stressed that it’s always best when it’s detected early, and one of the best ways to do that is to get screened.

“We don’t want men to be scared. I think it’s more important for them to come and learn what are the pros and cons of screening and at least utilize the non-invasive method that will give them the best information for informed decision making.”

Read more about prostate cancer screening in a post by Dr. Hwang on the .

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