Former President Joe Biden’s aggressive prostate cancer diagnosis has raised questions about prevention and detection.
The U.S. Preventive Services Task Force (USPSTF) recommends that men aged 55 to 69 discuss the potential benefits and risks of PSA (prostate-specific antigen) screening with their healthcare provider and make an individual decision about screening.
They recommend that men over the age of 70 skip screenings altogether.
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The USPSTF is a “commonly used” resource, although other agencies and associations offer varying guidelines, according to Dr. Shawn Dason, a urologic oncologist at The Ohio State University Comprehensive Cancer Center.
Dason stressed that it’s important for men in their 50s and 60s to confer with their healthcare providers to make shared decisions on screening.
“They should engage in a discussion about the topic of prostate cancer and the role of PSA in screening — and the potential benefits and harms,” he said.
Potential risks of screening and treatment
There’s a “little bit of variability” in whether men under age 50 and over 70 should be screened due to potential risks, which can include over-treatment or unnecessary treatment, Dason said.
In past decades, “we didn’t really have an understanding of the nuances … about when prostate cancer should be treated and when [it] should just be observed in a protocol called ‘active surveillance,’” he said.
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It is possible for some men to be over-treated after a diagnosis, he also said.
In certain cases, the cancer may not have led to death or other clinical problems — but the treatment could cause “bothersome” urinary, sexual or bowel-related side effects, Dason said.
“You might be diagnosed with a prostate cancer that is not likely to actually cause your death or create any other problem for you,” he said.
“You might then receive treatment for that prostate cancer — and the treatment might be worse than the actual impact of the cancer itself.”
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There is “much more limited data” to support that screening over the age of 70 could save a man’s life from prostate cancer, Dason noted, while it’s “pretty clear” that the harms of prostate cancer treatment increase with age.”
Screening could reduce the chance of death in some cases, however, which is why it’s important to have a discussion with a doctor, according to Dason.
Men who don’t have symptoms but are considered of “average population risk” should be screened, he advised.
“Having symptoms is a totally different conversation,” he said.
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“Generally, when we use the term screening, we’re talking about somebody who is not having any symptoms … They’re having an annual health checkup.”
Screenings for men over age 70
Fox News’ senior medical analyst Dr. Marc Siegel revealed that he’s been “bothered” by the guidelines not recommending routine prostate cancer screening, particularly for those over age 70.
“Studies have shown that use of the PSA has fallen off in men over the age of 40 as a result of the USPSTF recommendation,” he wrote in a recent op-ed for Fox News Digital.
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“This is particularly disturbing considering that there are over 300,000 new cases of prostate cancer in the U.S. diagnosed every year, with over 35,000 deaths, many of which may be preventable with earlier diagnosis.”
“I am saying that all men over the age of 45 should have this screening. Period. Regardless of age.”
Siegel noted that treatment options have advanced over the years, and are now better tolerated with fewer side effects for patients at various stages and ages.
“Many critics are saying that a president of the United States should have the most aggressive prostate cancer screening regardless simply because he is president,” he said.
“But I am saying that all men over the age of 45 should have this screening. Period. Regardless of age.”
Dason agreed that some men aged 70 and older are appropriate candidates for screening.
“If you’re in good health, and you’re going to have a reasonable life expectancy, the diagnosis of [a serious] prostate cancer could have a big impact on extending that life or improving your quality of life.”
By contrast, men who are not great candidates due to health issues and limited life expectancy face greater harm from a screening than benefit, he clarified.
“I would encourage men to think about their situation and have a conversation with their medical provider.”
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