Virginia Commonwealth University

VCU Massey Cancer Center

Early detection of prostate cancer? It's complicated.

Prostate cancer is the most common cancer among men, excluding skin cancer. It may also be the most controversial. In the United States, most men over the age of 50 years have had a prostate-specific antigen (PSA) test for prostate cancer, despite the muddled evidence of a net benefit.

In 2012, U.S. Preventive Services Task Force's guidelines for prostate cancer screening were updated due to these controversies and additional studies. These guidelines recommend that doctors stop doing routine PSA tests. Not everyone agrees with these recommendations. Massey oncologists believe it is wise and appropriate to discuss screening options with your doctor.

The controversies do not end with whether or not to be screened. If diagnosed, should you be treated…

  • Aggressively?
  • With watchful waiting? 
  • With “active surveillance,” a new approach to managing prostate cancer?

Mayer Grob, M.D., associate professor and urologist at VCU Massey Cancer Center, suggests that active surveillance, which implies no aggressive treatment for prostate cancer at the time of diagnosis, is worth consideration. Given the potential side effects of surgical and radiation therapies, Dr. Grob recommends discussing the pros and cons of active surveillance and other strategies with your health care provider.

The benefit of active surveillance, which includes serial PSA testing and biopsies, is to avoid the potential risks of incontinence and impotence, side effects that can happen with treatment, especially in men who are highly unlikely to die from their prostate cancer. If active surveillance produces warning signs, such as a rise in PSA levels or evidence of higher grade or higher volume cancer, physicians will re-evaluate the benefits of treatment.

Other key screening recommendations are:

  • Asymptomatic men who have at least a ten-year life expectancy should have an opportunity to make an informed decision with their health care provider about screening for prostate cancer after receiving information about the uncertainties, risks and potential benefits associated with screening.
  • Men at average risk should receive this information beginning at age 50. Men at higher risk, including African-American men and men with a first-degree relative (father or brother) diagnosed with prostate cancer before age 65 should receive this information beginning at age 45. Men at appreciably higher risk (multiple family members diagnosed with prostate cancer before age 65) should receive this information beginning at age 40.
  • Prostate cancer screening should not occur without an informed decision-making process.