MAKING AN INFORMED DECISION

Prostate cancer is the second most common cancer in American men. In fact, about 1 man in 9 will be diagnosed with prostate cancer during his lifetime. Most treatable when caught early, men are often confronted with confusing and conflicting information about the value of prostate cancer screening.

During a free online health lecture, family medicine physician Kevin Bundy, MD, described the pros and cons of prostate cancer screenings. He began his presentation on a positive note, emphasizing, “Most men die with prostate cancer, not from prostate cancer.” He added, “Autopsy studies indicate that many men who died of other causes, also had prostate cancer that never affected them during their lives.”

What Is Prostate Cancer?

Dr. Bundy explained, “The prostate, is a small gland normally the size and shape of a walnut. It sits low in the pelvis, in front of the rectum, below the bladder and surrounds the urethra. Found only in men, the prostate produces fluid that helps carry sperm.”

Prostate cancer begins when cells in the prostate gland grow out of control.

About one in 36 men will die from the disease, however according to the American Cancer Society there are more than 3.1 million men in the U.S. who have been diagnosed with prostate cancer at some point who are still alive today. Dr. Bundy noted, “While this is the most common cancer in men, if found early, it is one of the most survivable forms of cancer.”

Who is At Risk for Prostate Cancer?

  • Men. All men are at risk.
  • Age. It’s rare for men under 50 to get this disease, the risk increases with age.
  • African American and Caribbean Men of African American Ancestry. There’s an increased risk factor for diagnosis and dying from prostate cancer for this population.
  • Family History. If a first degree relative, especially a brother, has prostate cancer it increases your risk of getting the disease.
  • Diet. Diets higher in animal fats and lower in vegetables increase one’s risk.

“Men have about a 12 percent lifetime risk of developing prostate cancer and a 2.4 percent lifetime risk of dying from prostate cancer,” said Dr. Bundy.

Screening Tests—Informed Decision Making

The goal of the screening is to reduce the percentage of men who die from prostate cancer. “It’s important to understand,” said Dr. Bundy, “screenings are given to those without symptoms, tounderstand the likelihood that they may have the disease.” He emphasized, “A screening can’t tell definitively if you have cancer. To know for sure, you would likely need a biopsy. This would involve having small samples of the prostate removed and analyzed.”

Types of Screenings

There are two types of screenings for prostate cancer:

1. Digital Rectal Exam (DRE)— During this exam, the doctor inserts a gloved, lubricated finger into the rectum to feel for any bumps or hard areas on the prostate that might be cancer. It is not however used any longer as part of a routine exam.

2. Prostate Specific Antigen (PSA)— This blood test checks the level of prostate-specific antigen in your blood. If your number is four or less, you’re within the normal range. The chance of having prostate cancer increases as PSA levels increase. Men with a PSA between four and 10 are in the borderline range and have a one in four chance of having prostate cancer. If the initial result is borderline, doctors may recommend repeating the test. For higher PSAs, doctors are likely to recommend additional tests.

It’s important to know, neither the PSA test nor the DRE is 100 percent accurate. These tests can sometimes have abnormal results even when a man does not have cancer (a false-positive result), or normal results even when a man does have cancer (a false-negative result).

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Watch a recording of the lecture on "Prostate Cancer Screening: Making an Informed Choice"

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Factors That Can Affect PSA Levels

The most common reason for an elevated PSA is the benign growth of the prostate. This happens in all men. Dr. Bundy explains, “With prostate cancer we see elevated PSAs. However, they can also be elevated from infection, trauma, sexual activity and even cycling.”

PSA levels can vary over time. Also, medications and drugs, including anti-inflammatories such ibuprofen, Aleve and Motrin, can also falsely decrease PSAs.

Screening Guidance: Weighing the Evidence

Dr. Bundy encourages patients to consider the pros and cons of screening to decide whether having a screening is the right choice for them.

Pros (based on an extensive European study)

  • The PSA test is easy, inexpensive and pretty accurate.
  • In men who screen regularly there is 20 percent lower chance of dying from prostate cancer after 13 years and a 30 percent lower chance of being diagnosed with metastatic prostate cancer.
  • It’s clear that screening more often results in finding the disease earlier.
  • We know that the five-year survival for early-stage prostate cancer is nearly 100 percent.

Cons (based on an extensive European study)

  • There is one fewer death for 1,000 men screened after 13 years (some studies have found no decrease in mortality).
  • 75 percent of men with an elevated PSA who received a prostate biopsy found out they did not have cancer.
  • The five-year survival rate for early stage prostate cancer is 100 percent (this is a pro and a con because the survival rate is the same in early prostate cancer at five years whether you treat it or not). Many of the cancers found are unlikely to cause death or disability.

How Do You Decide?

When deciding whether to have a screening, consider:

  • Do you want to know if you have prostate cancer?
  • Would you choose to be treated?
  • How do you feel about the risks of being treated?
  • How do you feel about the possibility of getting aggressive prostate cancer?
  • Would you be willing to accept the side effects from treatment in return for a small chance of living longer?

Dr. Bundy’s Approach

Dr. Bundy shared his approach to helping patients make a decision. He noted this is his opinion and approach and it does not reflect the opinion of Boulder Community Health or any of its providers.

Some patients have their own opinion on how to approach prostate screening. In this case, Dr. Bundy emphasized he will absolutely listen to the patient.

Other times, a patient will ask for his advice and guidance. Dr. Bundy in this case will educate the patient sharing:

  • Stats such:
    • If the test result is positive, it is only correct 30 percent of the time.
    • If the test result is negative, we can be 85 percent confident that you don’t have prostate cancer.
    • There is a 12 percent lifetime risk of developing prostate cancer and an 88 percent likelihood of not developing it.
  • Consider these odds and how you feel about them:
    • It’s more likely that your PSA test result be normal than positive—if it’s normal you likely don’t have prostate cancer.
    • If a patient’s PSA is higher, over 4, Dr. Bundy then relies on the advancements that have been made for managing elevated PSAs. He will share this information with his patient, so they aren’t mistakenly rushed in for surgeries, radiation or prostate biopsies.

To schedule an appointment with Kevin Bundy, MD, call (303) 415-7450.

Click here to view/download a PDF of slides from Dr. Bundy’s lecture on "Prostate Cancer Screening: Make an Informed Decision."