Prostate cancer: when to screen?

Apr 26, 2013

Prostate cancer is the most common cancer for men. But many of those malignancies develop so slowly, the patient is never effected by it. That fact has started a debate over who to screen for the disease, and when. Lorraine Rapp and Linda Lowen, hosts of WRVO's weekly health show "Take Care" spoke with Dr. Anthony Scalzo, a medical oncologist at Hematology/Oncology Associates of Central New York, about how men should deal with this issue.

Lorraine Rapp: Who is at greatest risk of getting prostate cancer?

Dr. Scalzo: The greatest risk any man has for prostate cancer is his age. But, you know, it's estimated that the incidence of prostate cancer in men in their 70s and 80s may be as high as 40 to 50 percent, yet most of those men will not die from prostate cancer. The second risk factor is, I would say, genetics. If you have a first degree relative, either a father or a brother, with prostate cancer, then your risk of prostate cancer is higher. Also, we know that the same genes that are associated with a higher risk of breast cancer, the BRCA, or BRCA-1 and BRCA-2 genes, if a male has one of those genes, his risk of prostate cancer is higher as well. The other risk factor is ethnicity, and we know that African American males have a higher risk of developing prostate cancer, as well as a higher risk of having more aggressive prostate cancer.

Lorraine Rapp: The disagreement within the medical community seems to be about who should get the routine screening. Early detection may find cancers that would never have needed to be treated, other argue that finding prostate cancer early may save lives. So, can you talk about what the latest thinking is and how its developed over time?

Dr. Scalzo: Screening means, in a completely asymptomatic individual, looking to see if there is an elevation of the PSA that might suggest prostate cancer, and the idea that can be found early when its localized to the prostate gland, then it can be cured with local treatments. The controversy arises because some of these cancers that are found may be biologically insignificant, meaning that they may grow so slowly that they may never cause difficulty for the male, they never cause symptoms, and they may never limit his survival. And with the state of knowledge that we have right now, we can't determine which of these cancers are going to be aggressive and really require treatment, or which can be simply monitored and may not require treatment. So the concern with screening is that we're going to be treating men that don't need to be treated, and the treatment which includes radiation and surgery are not benign treatments, and they have side effects.

Linda Lowen: When does screening typically begin for an average man that has no family incidence of  prostate cancer?

Dr. Scalzo: If you are not African American and if you have no family history, and you don't have that genetic BRCA background I discussed, then at the age of 50, if you don't start screening, but you discuss the issue with your physician, and you discuss the pros and cons of screening--now, if you're in a high risk group, I think it's a different situation. If then, screening should begin at the age of 40.

Linda Lowen: It's a difficult topic to discuss, and, you know, for a man 50 years old who's facing screening and knowing what the options are, it's helpful to know that prostate cancer is not necessarily a fatal disease, and sometimes a watch and wait approach is best.

Dr. Scalzo: In some cases, that's true. And it's very curable up front with the appropriate treatment for the appropriate patient. Many patients, even with metastases now, will live years and not months. And I think the whole treatment of prostate cancer has changed dramatically in the last 5 years. There's much more hope now than there was even 5 years ago.

More of this interview can be heard on "Take Care," WRVO's health and wellness show on Sundays at 6:30 p.m.  

Support for this story comes from the Health Foundation for Western and Central New York.