Guidelines for Prostate Cancer Screening Revised

by Sandra Crockett

When it comes to cancer screening, the process of early detection and treatment seem straightforward. But slightly revised guidelines from the American Cancer Society encourage physicians and patients to have a conversation about prostate cancer. The goal is to help men in their decision-making process regarding screening.

“We are now at the beginning of a very large conversation with the public over treatment of prostate cancer,” says S. Mark Redwood, M.D., Chief of Department of Urology at Sinai Hospital.

The guidelines focus on men with no symptoms of prostate cancer who can expect to live at least 10 more years. These men are encouraged to discuss the uncertainties, risks, and potential benefits associated with prostate cancer screening with their physician, with the talks starting at age 50. Men with no symptoms who are not expected to live more than 10 years (due to their age or health conditions) should not be offered prostate cancer screening.

The risks or side effects of treatment may outweigh the benefits of treatment, the ACS says.

“What is new is the direct statement that if a patient has many (serious) conditions such as diabetes, heart disease, or other illnesses that would shorten his life, less aggressive approaches should be taken with respect to screening for prostate cancer,” Dr. Redwood says.

However, this opens another dilemma. “The problem arises in the judgment of what constitutes a serious co-morbid condition and what is less life threatening,” he says.

What also hasn’t changed is the ACS recommendation that African-American men, and men who have a father, brother, or son diagnosed with prostate cancer before age 65 begin discussing screening options at age 45. Men with multiple family members affected by the disease before age 65 can start at age 40.

Prostate cancers are now being classified into low, intermediate and high risk, Dr. Redwood says. If the man is still undecided after talking with their doctor, ACS recommends the doctor make the call based on his or her knowledge of the patient's health preferences and values.

“We are fortunate to have multiple modalities for prostate cancer treatment, including Cyberknife, prostatic brachytherapy, da Vinci Robotic Prostatectomy and cryoablation of the prostate at the the Alvin & Lois Lapidus Cancer Institute at LifeBridge Health,” Dr. Redwood says.

It would benefit the patient and his family to have these conversations with a LifeBridge physician who is comfortable with presenting all aspects of management.

“We provide comprehensive care of prostate cancer,” Dr. Redwood says.

For patient education and availability of comprehensive services for prostate cancer management, LifeBridge Health invites patients and their families to participate in this new dialogue now encouraged by the ACS guidelines.

To make an appointment with a urologist, please call 410-601-WELL (9355).