Written by Gabrielle Sellitti
You may have heard conflicting information about prostate cancer screenings. There has been an ongoing debate on whether or not the PSA test in the routine annual prostate cancer screening is necessary. In 2018, the U.S. Preventive Services Task Force (USPSTF) made recommendations that men aged 55 to 69 years should individually decide if they need screening, while recommending that men 70 years or older should not be screened at all1. This recommendation applied to all men whether they have average or increased risk for prostate cancer, or have no symptoms or diagnoses of prostate cancer at all.
The Center for Disease Control and Prevention (CDC) follows the prostate cancer screening recommendations, and argues that a PSA test may have false positive or false negative results. This can mean that men without cancer may have abnormal results and get tests that are not necessarily needed. It, unfortunately, also means that a test might miss a cancer diagnosis in men who may need to be treated2. Before making any decisions on screenings, men should consult with their doctor about the benefits and harms of screening for prostate cancer, including the risk factors that come with testing and treatment. Screening is typically reserved for men with a life expectancy estimate of 10 or more years.
Alexandre Rosen, M.D., Board Certified Urologist with Physicians Regional Medical Group, believes this argument has had negative effects. “The frequent debate in the past 5-10 years has led to patient and physician confusion as to who should be screened. The urology community strongly believes that screening for prostate cancer is important and saves lives by making an early diagnosis.”
Prostate cancer is the seconding leading cause of cancer death in American men. Even though most men diagnosed with prostate cancer do not die from it, 1 in 9 men will be diagnosed with prostate cancer during his lifetime. The average age of diagnosis is about 66 years of age3. Dr. Rosen recommends that PSA screening and prostate exams should begin at age 50, unless men have additional risk factors. These include being African-American or having a family history of prostate cancer. Gene mutations such as BRCA (associated with breast and ovarian cancer) may also contribute to prostate cancer. For higher-risk patients, Dr. Rosen typically starts screening men at age 40.
Benjamin Barckley Storey, M.D., another Board Certified Urologist with Physicians Regional Medical Group agrees with Dr. Rosen. “I’m a strong believer that we should collect all the information we need, and make an educated decision on possible treatment options going forward.”
A relatively new tool called Focal Biopsy has become available to urologists in the last few years to help them screen and biopsy patients with suspected prostate cancer. This system allows physicians to look for potential areas of concern within the prostate using Magnetic Resonance Imaging (MRI), and if found, use a new targeting system to sample those areas of concern. Ultrasound/MRI fusion Focal Biopsy lets the urologist take a lesion seen on MRI, and guide a needle specifically to that area to biopsy. Dr. Storey points out several advantages to this system over the old way of approaching an abnormal PSA or rectal exam:
• By using MRI, it allows us to target lesions that are of higher concern, yielding much higher quality biopsies.
• It allows a method to screen patients who historically have high or unstable PSA, and who would otherwise be subjected to repeat prostate biopsies.
• This system is invaluable for the patient who has had a negative prostate biopsy, but whose PSA continues to rise. We can now look for a lesion, and target it, instead of continuously “stabbing in the dark.”
“I would estimate a large number of studies currently being done across the country involve Focal Biopsy systems, and this is rapidly becoming a standard of care in urology,” says Dr. Storey.
Dr. Rosen’s office is located at Physicians Regional – Pine Ridge, 6101 Pine Ridge Road.
Dr. Storey’s office is located at Physicians Regional – Collier Boulevard, 8340 Collier Boulevard and Physicians Regional – Marco Island, 1839 San Marco Road.
Dr. Rosen and Dr. Storey are now accepting new patients. For more information or to request an appointment, please call (239) 348-4221, or visit
PhysiciansRegionalMedicalGroup.com.
1 https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/
prostate-cancer-screening
2 https://www.cdc.gov/cancer/prostate/basic_info/get-screened.htm
3 https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html