What Women (and Men) Need to Know About Prostate Cancer Screening: Part 1  

Recently, I gave a talk on what women need to know about prostate cancer.  It was supposed to be for 20 minutes, but it went on for well over an hour because the ladies, ranging from their 30s to 70s, had so many questions.  So…Ladies, this one is for you.  Actually, it is for men in their 40s and 50s, but they probably won’t read it. 

I can attest that this is true.  My own dad, diagnosed in his early 60s with prostate cancer and cured by Johns Hopkins urologist Patrick Walsh, M.D. (my longtime co-author of now seven books on the subject) never read our book. Instead, my mom read it to him, passages she had previously highlighted, as they drove up I-95 from South Carolina to Baltimore for the surgery that saved his life and enabled him to live 20 more years.  In fact, my mom and I were the ones who made him start getting his prostate checked in the first place, something he definitely did not want to do.

When my husband, Mark, at age 59 found out that his PSA went up from a 2.0 – which I had thought was high and was watching it – to a 3.0, and his local doctor said it was “still low and in the normal range” (this was garbage; we disproved this in our books in the early 2000s), I recommended a second-line blood test (see Part 3) for clarification.  When that suggested cancer, I said:  “You need an MRI and a biopsy.”  He wasn’t convinced, and his local doctor said he could wait a while and see (really bad advice).  I called Pat Walsh, who not only told Mark the same thing, but told him which doctors he had picked out to do the biopsy and the surgery.  Thank God we got it when we did, and Mark is now cancer-free.  You can read Mark’s story here.

I have several key points for you to consider:  One, the younger men who are most likely to be cured of prostate cancer or, if it is slow-growing, followed carefully in active surveillance, are the least likely to be checking for it. ***Note***If a man is already getting PSA testing and wants to know more about the numbers, jump right to Part 3.***

Two, for whatever reason, more people are being diagnosed with cancer at a younger age.  You can take your pick on the reasons, and I have some thoughts, but the point is simply that it’s happening, and younger men need to start getting checked.  Because prostate cancer, when caught early, is 100 percent curable.

Three, despite what your family doctor may say, men need a baseline PSA blood test starting at age 40.

It’s just a simple blood test.  We will talk more about this in Parts 2 and 3.  (Personal note, because we have a high-risk family with six men affected so far on both Mark’s and my sides, I am going to make my sons get a baseline test at age 35.)  Also, we will talk about what the PSA numbers should be, and about more specific, second-line blood tests that can help determine if it’s cancer.  Please keep reading!

Four, treatment for prostate cancer is better than ever.  And, a diagnosis of prostate cancer doesn’t always mean that a man needs to be treated right away.  Many men can be treated for years or even indefinitely with active surveillance: they are followed carefully, and then treated only if and when the cancer starts to progress.  If a man does need treatment, surgery and external-beam radiation therapy are better than ever.  And: new advances suggest that in the next few years, we will see more and more focal therapy (treating only the cancer within the prostate, not removing the whole prostate), and even partial prostatectomies (like a lumpectomy for breast cancer).  We’re not there yet, but with better imaging and with in-surgery use of tracers such as the PSMA-targeting radionuclides, which can light up tiny spots of cancer invisible to the naked eye in PET imaging, it will be possible during surgery to know which tissue can safely be spared.  This should help minimize side effects of temporary urinary incontinence and ED.  Where surgery goes, radiation goes, as well, and I predict more nerve-sparing forms of radiation therapy and even more highly targeted therapy that will minimize side effects, too.

Step one: Get the baseline PSA.  Ideally, at age 40, but in the 40s is better than waiting until age 50.  (However, if a man is in his 50s and hasn’t had a PSA test, he needs to get one!)

            Note:  This is not a “one and done” thing.  What happens next depends on the number.  If a man’s PSA is lower than 1 ng/ml, the doctor may say he can wait two to four years for the next one.  However, if the man is at high risk for prostate cancer – if he has a family history of cancer and/or prostate cancer, or if he is of African descent – he should just get on the PSA train and get screened every year.

            Here’s something to think about:  A lot of men don’t know their family history.  So how do they know if they are at higher risk of getting prostate cancer?  Also, for many people, including our family, the family history changes in real time.  When Mark and I got married, we didn’t have any prostate cancer in the family.  Then his dad died of it at age 53, his maternal grandfather died in his 80s of complications from radiation that he probably didn’t need, my grandfather died in his 80s of complications from estrogen (they don’t even use that now) that he probably didn’t need, either.  Then my dad got it.  Then Mark, and then his paternal uncle.  So we’re six and counting.  But again, we weren’t a prostate family… until we were.

Next:  Part 2:  Why is PSA Screening Such an Issue?

In addition to the book, I have written about this story and much more about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org. The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  As Patrick Walsh and I have said for years, Knowledge is power: Saving your life may start with you going to the doctor, and knowing the right questions to ask. I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease. Many doctors don’t do this, so it’s up to you to ask for it.  Note: I am an Amazon affiliate, so if you do click the link and buy a book, I will theoretically make a small amount of money.  

© Janet Farrar Worthington