;e blood test for prostate cancer involves checking PSA
levels. PSA (protein-speci;c antigen) is a substance that can
be produced by either cancerous or noncancerous cells within the prostate. A PSA above 4 ng/ml (nanograms per milliliter) can signal prostate cancer, or it can indicate an enlarged
prostate or another non-cancerous prostate issue. Prostate
cancer can be present with low PSA levels as well. Studies
have shown that routine PSA screening has little to no effect on survival rates, and overtreatment can result in issues
including erectile dysfunction, bleeding, incontinence, impotence, and di;culty urinating. Even if you are diagnosed
with prostate cancer, in some cases “active surveillance” or
“watchful waiting” may be the correct option, however for
some men, the knowledge that he has cancer but isn’t “doing
something” about it can cause severe distress.
Current guidelines for PSA testing (assuming you are at
average risk for prostate cancer) are:
• American Urological Association: No routine PSA
screening if you’re over 70 or have a life expectancy of
fewer than 10 to 15 years. If you’re younger than 70, dis-
cuss whether or not to have PSA screenings with your
• American Cancer Society: Make an informed decision
in conjunction with your health care provider.
• U.S. Preventive Services Task Force (USPSTF): Recommends against PSA screening. ;e USPSTF states:
“;ere is adequate evidence that the bene;t of PSA
screening and early treatment ranges from zero to one
prostate cancer deaths avoided per 1,000 men screened.”
Bottom Line: About one man in 39 ( 2. 58 percent) will
die of prostate cancer. Black men and men with a family
history of prostate cancer are at higher risk. In most cases,
a man with prostate cancer will die from something other
than this (usually) slow-growing cancer. According to the
American Cancer Society, prostate cancer is rare before the
age of 40, and 66 is the average age of diagnosis. Discuss
with your health care provider to make the decision that is
right for you.
Aside: My husband, a;er a lot of reading and discussions
with his doctor, decided to discontinue PSA testing. On the
other hand, several of my male friends have insisted that the
PSA test saved their lives.
Good news: All major health agencies agree screening for
colorectal cancer should start at age 50, assuming an average
risk for colorectal cancer. Bad news: About a third of Americans aged 50 to 75 have had NO screening for colorectal cancer. Good news: Screening does not have to involve a colonoscopy, which for many people has a big “yuck” factor, not
to mention the prep, having someone drive you home a;er
the procedure, cost, etc.
In the United States, a colonoscopy is considered the “gold
standard,” but the best screening for colorectal cancer is the
one you will actually DO. Alternatives to colonoscopy include
;exible sigmoidoscopy, CT colonography, and looking for
signs of cancer in the stool through the fecal occult blood test
(FOBT), fecal immunochemical test (FIT), or Cologuard. If
your results are positive for these alternative screenings, you
will mostly likely need a colonoscopy.
Current guidelines for colorectal screening (assuming
average risk for colorectal cancer) are:
• American Cancer Society: Start screening at age 50
(no upper limit for testing speci;ed).
• Centers for Disease Control and Prevention: Start
screening at age 50; if you’re between the ages of
76 and 85, discuss whether you should continue to
screen with your health care provider.
• U.S. Preventive Services Task Force: Start screening at
age 50 until the age of 75.
Bottom Line: Over a lifetime, according to the American Cancer Society, the risk of developing colorectal cancer
is about one in 23 ( 4. 4 percent) for women and one in 21
( 4. 7 percent) for men. It’s estimated that about 50,260 people
will die from colorectal cancer during 2017. ;e great thing
about colonoscopies is that they can prevent cancer by removing pre-cancerous polyps during the procedure.