HJAR Sep/Oct 2022

46 SEP / OCT 2022 I  HEALTHCARE JOURNAL OF ARKANSAS DIALOGUE COLUMN UROLOGY SEPTEMBER is Prostate Cancer Awareness Month. Prostate cancer screening is key to the early diagnosis and treatment of men with prostate cancer. Unfortunately, we have seen two events — USPTF’s incorrect recom- mendation against PSA screening that was subsequently corrected and COVID-19 — in the past decade that have led to decreased prostate cancer screening, and because of these, we have seen a rise in the de novo diagnosis of metastatic prostate cancer. 1 Prostate cancer accounts for 15% of all diagnosed cancer cases inmale patients and is one of the most often-diagnosed forms of cancer in the world. The American Can- cer Society estimates that in 2022, around 260,000 men in the U.S. will be diagnosed with the disease, with over 34,000 Ameri- cans dying from prostate cancer this year. One in eight men will be diagnosed with prostate cancer in their lifetime. In addition to being one of the most com- mon forms of cancer, it is also one of the most treatable. Over 96% of patients with prostate cancer live at least five years be- yond their diagnosis. By comparison, the five-year survival rate following a lung can- cer diagnosis is just 18.6%. 2 Who are the men we should be screening? There are a few things we need to consider when deciding if a man should be screened: age, life expectancy, and family history of Efforts to understand the causes of pros- tate cancer are ongoing, but a preventative smoking gun on par with a factor like the connection between tobacco use and lung cancer has yet to be discovered. Most com- mon risk factors for other cancers — includ- ing diet, obesity, hormone levels, occupa- tion, sexually transmitted disease, andmore — haven’t consistently been shown as predic- tors for who will develop prostate cancer. 5 That said, there are a handful of factors that are known to increase a patient’s risk. Age is one of the most important risk fac- tors for prostate cancer. The disease is rare in men under the age of 40. After age 50, how- ever, the diagnosis rate rises. Around 60% of prostate cancers are diagnosed in men over the age of 65, with the average age of diagnosis being 66. Genetics can also play an important role, even though prostate cancer is most often diagnosed in those without a family history of the disease. Having a father or brother who was diagnosed with prostate cancer roughly doubles a patient’s risk. If the patient has multiple close relatives who have been diagnosed, that can also increase a patient’s risk even further, especially if those relatives were diagnosed earlier in life. Several inher- ited (germline) mutations raise the risk of prostate cancer, including BRCA 1 or BRCA 2 as well as Lynch Syndrome (MLH1, MSH2, prostate cancer. If a man has a life expec- tancy <10 years, it is not recommended to perform prostate cancer screening. The guidelines recommend prostate cancer screening for men aged 55 to 69. For men aged >70, routine screening is not generally recommended, but I do screen men in this age group if they are healthy and I suspect their life expectancy is >10 years. While the general recommendation is against pros- tate cancer screening in the age group 40 to 55, there is literature supporting checking a PSAbetween the age of 40-49 to determine a patient’s lifetime risk of developing a lethal prostate cancer. If the patient’s PSAis <1, there is very little risk of developing a lethal pros- tate cancer; but if their PSAis >1, these are the men that require closer follow-up. 3 Also, for men younger than 55 years old at higher risk (e.g., AfricanAmerican and/or family history of metastatic or lethal adenocarcinoma in- cluding prostate, breast, ovarian, and pan- creatic cancer), the decision for screening should be individualized. 4 Annual screening is standard for routine screening, and I utilize this for men whose PSA is >1. However, increasing the interval of screening to every two years for men whose PSA is <1 preserves the majority of the benefits and reduces overdiagnosis and false positives and is recommended by the American Urologic Association guidelines. 4 PROSTATE CANCER: A Call to Arms … Fingers