Benefits include early detection, offering a better chance to cure the disease if your cancer warrants treatment.
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When to start screening is generally based on individual risk. If you have any symptoms, you and your doctor will determine what the next steps should be. Ultimately, PSA screening decisions should be made on a case-by-case basis between the doctor and patient, based on a full examination of risk factors. Increasingly, doctors are discovering that many prostate cancers are genetic, that is, inherited through families.
Read more about the genetics of prostate cancer risk. When to Start—and Stop—Screening The doctors and researchers who recommend screening argue that cases of prostate cancer found very early can be cured more quickly, with less chance of relapse or spread.
Those who recommend against routine screening point to the slow-moving nature of prostate cancer and the side effects of surgical and medical treatment, which can be considerable. The introduction of PSA screening in the US led to an initial increase in the number of prostate cancer cases diagnoses each year in the USA, but many of these new cases were non-aggressive or low-risk prostate cancer. Very few men will die of these less-aggressive forms of prostate cancer in the first decade after diagnosis.
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It seems very strange to say that a patient might be better off leaving cancer untreated, but in some cases, it can be true. Screening and Biopsy PSA screening may reveal results that prompt a doctor to recommend a biopsy. However, the result may create more confusion. If the PSA is only mildly elevated, the next steps may not be clear. Once the diagnosis of prostate cancer is confirmed by biopsy, PSA is still used for monitoring the status of the cancer, and the interpretation of results depends on how the cancer is managed.
Prostate cancer screening
A high PSA level can be a sign of prostate cancer. However, other noncancer conditions such as an enlarged prostate or inflammation of the prostate can also cause a high PSA level. A biopsy of the prostate gland is necessary to make the diagnosis of cancer. This USPSTF recommendation applies to adult men without symptoms of prostate cancer, including those with risk factors for prostate cancer such as black race and family history of prostate cancer.
The goal of screening for prostate cancer is to find more aggressive prostate cancers earlier, which would lead to earlier treatment of and decreased death due to advanced or metastatic prostate cancer. However, based on current data from randomized clinical trials, no mortality benefit has been seen from screening men aged 70 years or older. Potential harms of screening include false-positive results that lead to unnecessary biopsies, as well as overdiagnosis and overtreatment, which can reduce quality of life.
The USPSTF concludes with moderate certainty that for men aged 55 to 69 years, the potential benefits and harms of screening for prostate cancer are closely balanced. The decision for screening should be discussed between physicians and individual patients and made based on individual preferences, values, and risk factors.
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For example, if someone is not willing to go through treatment and risk side effects of long-term impotence and incontinence, he should not be screened. For men aged 70 years or older, the USPSTF concludes with moderate certainty that the potential harms of screening for prostate cancer outweigh the potential benefits. Jin J. Screening for Prostate Cancer.
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The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients.
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