Men's Health: Prostate Cancer Screening for Men Aged 40 and Older

If you’re a man aged 40 or older in the Mid-Ohio Valley, you’re probably aware of prostate exams, or you may have received information about them from a family member or friend. In 2023, The American Urological Association, Inc. (AUA) released updated guidelines for prostate cancer screening, aimed at improving early detection. Current statistics from the American Cancer Society reveal that 1 in 8 men in our community will be diagnosed with prostate cancer during their lifetime, making it the second most frequently diagnosed cancer in our area.

In the past, doctors routinely conducted annual digital rectal examinations (DRE) and serum prostate specific antigen (PSA) tests for men aged 50 and older. However, for individuals with specific risk factors, such as a family history of prostate cancer or African American heritage, screening would commence at the age of 40. Carson Wong, MD, FRCSC, FACS, a double board-certified Urologist specializing in prostate cancer treatment at Marietta Memorial Hospital, emphasizes the importance of understanding the new guidelines for early detection and screening. Dr. Wong highlights the fact that many men show no symptoms, underscoring the need for regular screenings. He stresses that these guidelines should not be seen as a one-size-fits-all approach, as the presence of symptoms, also known as lower urinary tract symptoms (LUTS), genetic factors, and ethnicity need to be considered. Also, it is crucial to recognize that not all prostate cancers are the same, with variations in aggressiveness. Managing this condition should be tailored to each individual patient’s specific circumstances, involving shared decision-making (SDM) between the patient and their Urologist. On the next page, Dr. Wong outlines several AUA Guidelines and provides his perspective.

1. When screening for prostate cancer, PSA should be used as the initial screening test.

Dr. Wong: Agrees with this recommendation.

2. Clinicians may recommend a baseline PSA test for men between the ages of 45 and 50.

Dr. Wong: Agrees with this recommendation.

3. Clinicians should consider offering prostate cancer screening between the ages of 40 and 45 for those at an elevated risk of developing prostate cancer (e.g. family history of prostate cancer or African American descent).

Dr. Wong: Agrees with this recommendation.

4. Clinicians should offer regular prostate cancer screening every two to four years for men aged 50 to 69.

Dr. Wong: Cautions this guideline, noting that the suggested screening interval is quite wide. It may be suitable for only a select group of individuals with an extremely low risk, low PSA value, and high compliance. For most men in this age group, annual screening is likely more appropriate.

5. Clinicians may tailor the re-screening interval based on patient preference, age, PSA values and trends, life expectancy, and overall health status following SDM.

Dr. Wong: Agrees with the importance of personalizing the screening interval based on individual factors and preferences.

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