La guía de prevención de cáncer de próstata para hombres de más de 65

Experts weigh in on screening tests to protect yourself — and what you can do if you’re diagnosed with it.

The term "prostate cancer" is scary, and it's a diagnosis you should take very seriously. But when caught early, this type of cancer is rarely deadly. The American Cancer Society says that if prostate cancer hasn't spread, you're 99% as likely to live for another five years as someone who doesn't have the disease.

Screening tests can help you catch cancer at this critical early stage, as well as help determine if you need treatment. Learn more about those, plus what your treatment options are if you're diagnosed with prostate cancer.

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Who should be screened for prostate cancer?

The American Urological Association recommends that men between ages 50 to 69 undergo prostate cancer screening every two to four years.

To decide how often to get screened, discuss your options and risk factors with your doctor. You'll likely want to get screened more often if you have a strong family history of cancer, suggests Akshay Sood, M.D. He is an assistant professor of urology at the Ohio State University James Cancer Hospital. You might get screened less often if your cancer risk is lower, he says.

Your doctor can also help you determine if additional screening makes sense after age 69. These are the risk factors that can impact if and how often you need to be screened:

Your age. It can take a decade or longer for prostate cancer to grow large enough to cause symptoms like incontinence and sexual dysfunction. Because of that, you might decide screening is worth it when you’re in your early 70s, but not worth it once you reach your mid 80s or early 90s, says Dr. Sood.

Your health. “If you likely have 20 to 25 more years to live, you should get screened,” says Dr. Sood. But if you’ve been diagnosed with a life-threatening disease, you may be much more likely to die from that than undiagnosed prostate cancer, he says.

Your family’s cancer history. If you have a first-degree relative (father or sibling) who died from prostate or another type of cancer, your risk is much higher, says Dr. Sood.

What are PSA tests?

Prostate-specific antigen (PSA) tests are currently the gold standard in prostate cancer screening. PSA tests search for markers in the blood that put you at higher risk for the disease.

According to the American Cancer Society, if your PSA level is between 4 and 10 ng/ml, you have a one in four chance of having prostate cancer. If your PSA level is above 10, your risk is more than 50%.

Other conditions — such as urinary tract infections and an enlarged prostate — can lead to rises in PSA too.

"The issue with PSA testing is that we want to avoid going down the rabbit hole of finding insignificant prostate cancer and creating anxiety for our patients," says S. Adam Ramin, M.D. He's the medical director of Urology Cancer Specialists in Los Angeles, California and he is on staff at Cedars Sinai Medical Center in Los Angeles. "At the same time, we don't want to miss the more significant types of cancer."

If your PSA levels are elevated, you'll need additional tests. Follow-up tests can help determine whether you need a prostate biopsy, if you have cancer, and how aggressive the cancer is, says Dr. Ramin.

What are the other follow-up tests?

Your doctor may want to do another PSA test in a few months and compare the results to your first test to see how quickly your PSA levels are rising, says Dr. Ramin. Additional follow-up tests include:

MRI of the prostate. Magnetic resonance imaging (MRI) allows your doctor to look inside your body to check your prostate health. This can help rule out non-cancerous causes of elevated PSA and see the size and location of any tumors.

Transrectal ultrasound (TRUS). Your physician inserts an ultrasound probe into your rectum. The sound waves create a black-and-white image. This can help your doctor determine the size of your prostate and see abnormal growths.

Free-to-Total PSA. This blood test measures the ratio of two types of PSA. Some PSA circulates in your blood attached to a protein carrier. Other PSA circulates freely without these carriers. The free PSA tends to be lower in men with prostate cancer.

Liquid biopsy. These tests look for prostate cancer DNA or RNA in your urine, says Dr. Ramin.

4K Score test. This combines the results of several PSA tests and some other factors to determine your cancer risk.

What is a prostate biopsy?

A biopsy is a procedure that removes a sample of cells from your body so it can be tested for cancer in a laboratory. Depending on the results of an MRI or other follow-up tests - along with your age, family cancer history and several other factors - your doctor may also suggest a prostate biopsy, says Dr. Ramin.

During this test, you'll be sedated. Then your doctor will insert a needle through your perineum and into your prostate to remove small samples of tissue, says Dr. Sood.

Not everyone needs such an invasive test, so ask your doctor these questions before deciding to have a biopsy done, says Dr. Ramin:

• Have you compared my current PSA level to my previous PSA results? If so, what do those comparisons tell you about my cancer risk?
• Are there other less invasive tests, such as a prostate MRI or liquid biopsy, that I should get before undergoing a biopsy?
• Would a follow-up PSA test be helpful before having a biopsy?
• How does my family history affect my prostate cancer risk?

What happens if I have prostate cancer?

If your biopsy reveals cancer, your age, health status, family cancer history, and type of cancer will determine your next steps, says Dr. Ramin.

“The cancer may stay dormant in your body, and it won’t necessarily cause problems for you,” says Dr. Ramin. Have frank conversations with your doctor about whether you are at high or low risk for the disease progressing to a more advanced, invasive form.

If you decide to undergo treatment, you have several options, says Dr. Ramin. Briefly, those include:

• Surgical removal of the prostate
• Radiation therapy to kill cancer cells
• Cryotherapy to freeze and kill cancer cells
• Drug therapy (such as chemotherapy) that targets cancer cells
• High-intensity focal ultrasound, which uses sound waves to destroy cancer cells
• Hormone therapy to suppress the male hormones (androgens) that fuel prostate cancer growth

Each option comes with a list of pros and cons. Some treatments are more effective at destroying cancer but are more likely to lead to side effects like erectile dysfunction. Others have fewer side effects but are less effective at treating the cancer. Make sure to discuss all of your options with your doctor, says Dr. Ramin.

Before making any treatment decisions, it’s also never a bad idea to seek a second opinion, says Robert Smith, senior vice president of early detection science for the American Cancer Society.

“Do not rush into therapy unless there is a good reason to do so,” he says.

See our sources:
Prostate cancer survival rates: American Cancer Society
Importance of early detection of prostate cancer: American Urological Association
Prostate cancer screening tests: American Cancer Society

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