Prostate Cancer

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James Mohler, MD, Roswell Park Cancer Institute, defines who is at risk for prostate cancer, how to decide who should be screened, and how to talk to patients about the test and their results.

James Mohler, MD, Roswell Park Cancer Institute, responds to recommendations from the US Preventive Services Taskforce to limit PSA testing by pointing out the benefits.

Marc B. Garnic, MD, addresses these questions in this short video. Dr Garnic, who spoke on this topic at the 2011 American College of Physicians meeting in San Diego

Looking at contemporary medicine’s complex landscape, especially in regard to soaring costs, can make practitioners dizzy. For example, if primary care physicians were asked whether it is cost-efficient and reasonable to screen with prostate-specific antigen (PSA) measurement for early-stage prostate cancer in men with terminal pancreatic cancer or to perform colonoscopy for early diagnosis of colon cancer in women with stage IV lung cancer, the answer would be a quick and uniform no. Unfortunately, a recent publication suggests that in the real world the answer has been yes, as disturbing and wasteful as that may be.

Benign prostatic hyperplasia (BPH)-histologically defined as stromal and epithelial hyperplasia beginning in the periurethral transitional zone of the prostate-affects up to 80% of 80-year-old men.[1,2] With progressive prostatic enlargement, bladder outlet obstruction can result. Although the exact mechanism is unknown, lower urinary tract symptoms (LUTS) can signal progressive BPH.

To screen or not to screen? The answer is not straightforward when it comes to prostate cancer. Recently updated guidelines from the US Preventive Services Task Force (USPSTF) recommend against prostate- specific antigen (PSA) screening in men who are 75 years and older and state that there is insufficient evidence to confirm whether screening is beneficial-or harmful -to men younger than 75 years.1,2 The recommendations are summarized in the Table.