March 16, 2009 -- Question: How does age affect prostate cancer risk, and at what age should one be screened?
Answer: Age is really the most dramatic factor that affects your risk of getting prostate cancer. Between the ages of 40 and 80, the risk of prostate cancer actually increases about 50-fold for men in the U.S. So it's really the most important factor. Most cancers that we see in adults increase dramatically with age. But prostate cancer has the biggest effect from age. We're not exactly sure why but it's really profound.
As far as cancer screening, even though the PSA test has been very successful in showing that we can identify men with very early prostate cancers, there's disagreement among major cancer organizations about whether you should get a prostate cancer screening test, what age you should get it, how often you should get it. Some organizations, like the national Preventive Health Services task force (U.S. Preventive Services Task Force) doesn't feel the evidence is strong enough that screening for prostate cancer will actually lower the risk that you could die from prostate cancer. But other organizations, such as the American Cancer Society, the American Urological Association, and the National Comprehensive Cancer Centers (National Comprehensive Cancer Network) feel strongly that screening with prostate cancer does have the benefit of lowering your risk of dying from the disease.
Since we've started using PSA, or prostate-specific antigen, for screening for prostate cancer, rates of men being diagnosed with metastatic disease have decreased by about 75 percent and rates of men dying with prostate cancer have decreased by about 35 percent and that's some of the evidence that those organizations use as a basis for saying that screening is worthwhile. They generally recommend that men get their first screening either around age 40 or around age 50.
For men who have a positive family history, either prostate cancer in a brother or a father, they recommend starting at an earlier age. African American men also have a high risk of prostate cancer and they should start at an earlier age as well. And then after you get that first screen the frequency of getting subsequent screens is something that you and your doctor will decide upon.