HERMISTON, Ore.-Prostate cancer is the second leading cause of cancer death in American men, behind only lung cancer and one in eight men will be diagnosed with prostate cancer during their lifetimes, according to the American Cancer Society (ACS).
Prostate cancer often grows slowly and the risk of developing the disease varies based on family history, race, and other factors, leading to uncertainty about when men should start screening.
“Screening is a shared decision between a man and his physician, weighing benefits against the risk of over-diagnosis,” said Dr. Cannon Milani a Hematologist and Oncologist with the Good Shepherd Health Care System (GSHCS) Cancer Center. “For men at average risk, that conversation should begin around age 45 to 50.”
Those at higher risk or who have a family history of prostate cancer should begin screening earlier, perhaps age 40-45.
The pros and cons of prostate cancer screening
Prostate cancer screening is testing to find cancer before a patient has symptoms, however, it’s not currently clear if the benefits of screening for prostate cancer outweigh the risks for most men, according to the ACS.
Men should discuss prostate cancer screening with their health care provider and make a decision on whether to screen based on the possible benefits, risks, and limits.
“I believe the primary care provider has a critical role of educating and personalizing care in this process as well as all other health education processes,” said Dr. Stewart Swena, of GSHCS Primary Care. “What is known from the peer-reviewed evidence, as well as the patient’s personal values and preferences must be taken into account.”
Because not all prostate cancers are the same, some are quick growing, while others grow so slowly that they would never cause health issues, the risks associated with screening include overdiagnosis, overtreatment and inaccurate or unclear test results.
Screening options for prostate cancer include the Prostate-specific antigen (PSA) blood test, digital rectal exam, magnetic resonance imaging (MRI), and possibly biopsy of the prostate.
“The cornerstone is the PSA blood test, a simple, low-cost blood draw that remains the recommended first step,” said Dr. Milani. “It’s strength is detecting disease early, before symptoms; its limitation is that elevated PSA levels can also come from benign enlargement or inflammation, which can lead to anxiety and unnecessary follow-up.”
Overdiagnosis is when a slow growing cancer that may never have caused health issues for the patient is found during screening and can lead to overtreatment of the cancer with surgery or radiation, which if not needed can cause quality of life issues, such as urinary, bowel, and sexual side effects.
Patients with low PSA levels can probably go two to four years between tests, while patients with higher PSA baselines should get tested yearly.
“PSA is the best screening test, and MRI, biomarkers, and biopsy work together to confirm a diagnosis while sparing many men an invasive procedure,” said Dr. Milani. “The biopsy itself, ideally MRI-targeted, remains the only way to definitively diagnose cancer.”
Family history, race, and prostate cancer
Having a father or brother with prostate cancer more than doubles a man’s risk of developing the disease, according to the ACS. Prostate cancer is also more prevalent among the Black male demographic.
“Family history and race are the two strongest risk factors,” said Dr. Milani. “Black men carry a higher risk of developing prostate cancer, tend to be diagnosed younger and with more aggressive disease, and have higher mortality, which is why guidelines recommend they begin the screening conversation earlier.”
The role that diet, exercise and overall health play in the development of prostate cancer is less clear.
Barriers to screening
In 2023, 33.8% of men between the ages of 55 and 69 reportedly had a PSA test within the past year, according to the National Cancer Institute.
Some of the barriers to prostate screening that persist are cost, access and stigma.
“Barriers include cost if they don’t have insurance coverage for screening, lack of access to primary care providers for various reasons, and fears that they may have regarding finding something they don’t want to find,” said Dr. Swena.
For Dr. Swena, evidence-based public education about the risks of prostate cancer and the benefit of screening, as well as raising awareness about lifestyle measures that can reduce the risk of cancer, would make prostate cancer screening both more accessible and less intimidating.
Screening and prostate cancer resources in Northeast Oregon
“Screening can be an important tool for discovering prostate cancer early when it may be able to be treated most effectively,” said Dr. Swena.
In Northeast Oregon, prostate cancer screening options and treatment resources are available through Good Shepherd Primary Care, Urology, and Cancer Center Clinics in Hermiston.
“Locally, our cancer program at Good Shepherd in Hermiston is a resource for men navigating an abnormal result or a new diagnosis, and we work closely with regional urology and primary care to make that pathway as smooth as possible,” said Dr. Milani.
GSHCS Primary Care is located at 600 NW 11th Street, Suite E-37 in Hermiston and can be reached at 541.567.5305. Appointments may also be requested online.
The GSHCS Cancer Center is located at 620 NW 11th Street, Suite M-102 in Hermiston and can be reached at 541.667.3615.
