Senior Urologist & Uro-Oncologist, Apollo Hospital Gurugram
Part 4 of 10 in Diagnosis and Management of Prostate Cancer
Who Needs Earlier Prostate Cancer Screening
July 7, 2024
Routine mass PSA screening, testing every man regardless of symptoms, is not recommended, since it has not been shown to improve overall cancer survival. But a defined high-risk group needs a much lower threshold for testing.
Who counts as high-risk
Anyone of African descent, anyone with a family history of prostate cancer or multiple other cancers, or anyone with a PSA density above 0.15, is at elevated risk and should be investigated earlier, starting at age 45 rather than waiting for symptoms. For this group, Dr. Shrivastava recommends a baseline PSA from age 40 and yearly testing from age 45 onward.
How often to re-test
For high-risk patients, yearly PSA testing is appropriate. If a PSA result comes back abnormal, it should be repeated after four to six weeks before deciding on further steps, since routine mass screening intervals don't apply once someone is in this high-risk category.
This article is based on a Jivo Masterclass session conducted by Dr. Nitin Shrivastava, Consultant, Urology and Uro-Oncology, Artemis Hospital, Gurgaon (his affiliation at the time of this session). The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr.Nitin Shrivastava taught doctors across Africa on July 7, 2024.
FROM THE LIVE Q&A
Moderator
What is the time range that should be considered between two PSA measurements during screening?
Dr.Nitin Shrivastava
Routine mass PSA screening is not recommended. But for high-risk patients, yearly PSA is a good idea. If the PSA comes out abnormal, it should be repeated after four to six weeks.
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Frequently Asked Questions
What is the best method of managing BPH?▼
First make sure BPH is not causing damage to the kidneys. For mild symptoms, only lifestyle management is needed. For bothersome symptoms, a single alpha blocker is used. There is no one universal method; if it's damaging the kidneys, surgery is needed.
Apart from PSA, what other hormones should be monitored in case of prostate cancer?▼
None. PSA is the only one.
What are the factors contributing to prostate cancer, and what are the staging parameters?▼
The most important contributing factor is genetics and family history. Researchers point to some role of obesity and possibly a non-vegetarian diet, but these risk factors are not firmly established.
What is a neobladder? What is an ileal conduit? How will treatment affect my quality of life?▼
Neobladder and ileal conduit are treatments for bladder cancer, not prostate cancer. A neobladder is an artificial bladder made from the patient's intestine, stitched together so the patient continues to pass urine through their natural passage. An ileal conduit instead diverts urine to exit through a different passage into a bag. On quality of life: what matters most in the long run is that the cancer comes out of the body completely; patients adjust well to either option over time.
Is there a limitation on the number of times TURP can be done on the same patient?▼
About 10 out of 100 patients will require another TURP within the following 10 years. There is no fixed limit, sometimes the prostate regrows fast and requires re-intervention, and sometimes it's done in stages. The more times TURP is repeated, the higher the chance of complications. Personally, the doctor has done it twice at most on the same patient.
Who should get earlier or more frequent prostate cancer screening?▼
Anyone of African descent, anyone with a family history of prostate or multiple other cancers, or anyone with a PSA density above 0.15, starting with a baseline PSA at 40 and yearly testing from 45.
Is routine mass PSA screening recommended?▼
No. Mass screening of asymptomatic men without risk factors has not been shown to improve overall cancer survival.
In This Series: Diagnosis and Management of Prostate Cancer
- 1.Diagnosis and Management of Prostate Cancer
- 2.Why Physical Examination Still Matters in Prostate Cancer
- 3.PSA Testing: Age-Adjusted Thresholds, Density and Velocity
- 4.Who Needs Earlier Prostate Cancer Screening
- 5.When to Biopsy: Balancing Missed Cancer Against Overtreatment
- 6.Biopsy Technique and Imaging: Transrectal vs Transperineal, CT vs MRI
- 7.Managing BPH: From Lifestyle to Alpha-Blockers to Surgery
- 8.TURP: How Often It Can Be Repeated, and the Real Tradeoff
- 9.After Prostate Surgery: Incontinence, Neobladder and Quality of Life
- 10.Nutrition and Multidisciplinary Care in Prostate Cancer