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At this time of year, I try to make sure my patients have had all the screening exams that should have been conducted this year. This is especially so when I see the men in my practice. Too many men are not as proactive about their health as I believe they should be. Many times, I am informed that they are in to see me only because their wife, mother or significant other has been the initiator of the visit.
I find this even more concerning as I read that the country of England has made some new recommendations about when they will screen men for prostate cancer.
As I researched this topic, I discovered that there is so much disagreement about when to start screening men, when to stop screening men, and at what intervals to screen men. In this country, four medical bodies have issued recommendations on this subject.
I understand the theory of, first do no harm, but I worry about missing the boat.
Let me simply summarize their recommendations.
The American Cancer Society recommends screening men who have a life expectancy of more than 10 years in a collaborative manner (shared decision making) between the patient and the medical provider, starting at age 50 for those of average risk, 45 for African American men, and 40 for those who have multiple family members with prostate cancer.
The National Comprehensive Cancer Network recommends baseline routine assessment for men ages 45 to 75 and for those with high risk, such as African American men and those with strong family histories, to start at age 40. They stratify other testing depending on the results of the PSA and only continue to test after 75 in healthy men.
The American Urological Association/Society of Urologic Oncology recommends shared decision making in men starting at ages 45 to 50 in those of average risk and 40 to 45 in men with increased risk such as African American men and those with strong family histories of prostate cancer. For men 55 to 69, only screen every two to four years.
The U.S. Preventive Services Task Force recommends that men at ages 55 to 69 practice individualized decision making with their doctor regarding periodic screening. Consider family history, race, comorbidity and patient values. After age 70, no screening is recommended.
The landscape is muddy here to say the least. I would like to see a consensus statement that really considers all the facts. I fear that it will not come anytime soon. Therefore, I encourage all men to make this decision with their healthcare providers (the shared decision-making aspect).
To make sure I am not missing any men with prostate cancer, I recommend that all men 40 and above receive PSA blood testing each year until the muddy waters on prostate screening and exams are cleared.
Dr. Veita Bland is a board-certified Greensboro physician and hypertension specialist. Dr. Bland’s radio show, “It’s a Matter of Your Health,” can be heard live on Wednesdays, 5:30 p.m. on N.C. A&T State University’s WNAA, 90.1 FM. Listeners may call in and ask questions. The show is replayed on Sirius 142 at 5 p.m. on Wed. Email Dr. Bland at ideas@blandclinicpa.com.
