PROSTATE CANCER SCREENING GUIDANCE
At what age should I be screened for prostate cancer? I have read different things about the best time to first have it done.
There are no hard and fast rules for when men should be screened for prostate cancer. This spring, however, the U.S. Preventive Services Task Force changed its prostate cancer screening recommendation. Previously, the task force recommended against this screening. Now it says the decision to get prostate cancer screening should be made on an individual basis, and men 55 to 69 should discuss with their health care providers if prostate cancer screening is appropriate for them.
Prostate cancer is common. Nearly one in seven American men are diagnosed with prostate cancer during their lives. Prostate cancer is also slow-growing. Most men with prostate cancer don't die from the disease. However, it is the third-leading cause of cancer deaths among men in the United States. That makes it an important issue that men should consider.
Health care providers use a blood test called the prostate-specific antigen, or PSA, test to identify prostate cancer in its early stages. PSA is a protein produced by cancerous and noncancerous prostate tissue. A small amount of PSA in the blood is normal.
Prostate cancer cells usually make more PSA than cells that are not cancer. That causes PSA levels in the blood to rise. So a PSA level that's higher than normal could be a sign of prostate cancer. But PSA levels also can be elevated in men with enlarged or inflamed prostate glands or for other reasons. That means determining the cause of a high PSA can be complicated.
The previous recommendation — that PSA was not useful as a screening test in healthy men with no symptoms of prostate cancer — was based on the fact that a PSA false positive result can lead to unnecessary tests, such as a prostate biopsy. And those tests come with medical risks.
Also, many cases of prostate cancer progress so slowly that they never require treatment. When those cancers are detected early with PSA screening, however, many men choose to go forward with treatment, such as surgery to remove the prostate gland or radiation, or both. These treatments could cause significant side effects, including impotence and incontinence. In these cases, the effects of treatment may be more harmful than the cancer itself.
The task force's new recommendation for men 55 to 69 emphasizes that the decision on whether to be screened for prostate cancer should consider individual factors, such as personal and family medical history, values and preferences. For some groups who are known to be at higher risk for developing prostate cancer, including African-American men and men with a family history of the disease, it may be useful to begin screening before age 55.
Some research also has shown that obtaining a baseline PSA measurement from men when they are in their 40s can be helpful to use for comparison when the test is performed in later years. If you're younger than 55 and interested in knowing your PSA, talk with your health care provider about getting a baseline test.
For men 70 and older, PSA isn't recommended as a screening tool. However, there are some men with a lack of significant health issues who still might benefit from a prostate check, including a PSA test. This is another reason to discuss it with your health care provider.
If you're concerned about your risk of developing prostate cancer, make an appointment to talk to your health care provider. He or she can help you sort out the risks and benefits of PSA testing based on your situation.
R. Jeffrey Karnes, M.D., Urology, Mayo Clinic, Rochester, Minn.
PANCREATIC CYSTS RARELY CAUSE PROBLEMS
What causes cysts on the pancreas? Can they become cancerous?
The reason cysts develop on the pancreas isn't known. But they appear to be related to the aging process, because they become more common as people get older. Most pancreatic cysts do not lead to health problems or require treatment. Only in rare instances do pancreatic cysts become cancerous.
Your pancreas is a long, flat gland in the upper abdomen behind your stomach that makes enzymes and hormones to digest food and process sugar. It is common for sacs of fluid, called cysts, to form on the pancreas, especially in adults over 65. These cysts typically don't trigger any symptoms. In most cases, they are found during imaging exams performed for another reason.
There are three basic types of pancreatic cysts: those that are not cancerous and stay that way, those that become cancerous over time and those that have cancer in them when they are found.
Although more than 99 percent of pancreatic cysts never will become cancer, finding one of these cysts causes a great deal of anxiety. Learning there's a growth on the pancreas leads many people to automatically think of pancreatic cancer and how difficult it can be to treat. With that in mind, it's recommended that when a pancreatic cyst is identified, you meet with a health care provider who specializes in disorders of the pancreas for further evaluation.
The evaluation usually includes a review of your medical history and family history, a physical exam and an assessment of the cyst's size, form, structure and location. Small cysts are less likely than larger ones to be cancer or become cancerous. If your health care provider suspects a cyst could be problematic, he or she may recommend additional CTs or MRIs.
When a cyst is large, another imaging exam, called an endoscopic ultrasound, also may be useful. It involves passing an endoscope, a small flexible tube, through your mouth to your stomach and small intestine. The endoscope is equipped with an ultrasound probe at the tip that enables your health care provider to see an image of your pancreas on a screen. In some situations, an endoscopic ultrasound may be paired with a procedure called fine-needle aspiration that takes tissue and fluid samples from the cyst. Then, those samples are examined to see if they contain cancer.
Because pancreatic cysts so rarely lead to cancer, the approach recommended most of the time is watchful waiting. Followup imaging is performed regularly to monitor the cyst. If it grows or changes, it may be necessary to drain the fluid from the cyst or remove it completely.
Rarely, a cyst may lead to pancreatitis, an inflammation of the pancreas. When that happens, medication and other treatment often can be used to treat the condition.
If you learn that you have a pancreatic cyst, the best course of action is to consult with an expert who is familiar with these cysts. A thorough evaluation followed by regular monitoring is all that's needed for most pancreatic cysts.
Suresh Chari, M.D., Gastroenterology, Mayo Clinic, Rochester, Minn.
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