Prostate exam: from what age does a man not need to do it?

US Preventive Services Task Force and College of American Physicians Release New Set of Guidelines on Routine Screening

The US medical community is concerned about the excessive exams for the detection of prostate cancer In old men and the consequent high rate of aggressive treatment in this age group, even in low-risk cases. In 2010, about 90 percent of Americans with low-risk prostate cancer had immediate surgery to remove the prostate or received radiation therapy, according to data from the American Urological Association.

According to the newspaper The New York Timesthe United States Preventive Services Task Force and the American College of Physicians have released a new set of guidelines advising against routine prostate cancer screening for men older than 69 or 70, or for men younger than to 10-15 years of life expectancy.

According to experts, the diagnosis of the disease tends to be followed immediately by treatment, overlooking the fact that in this age group most cancers are not likely to spread and/or cause bothersome symptoms before the patient dies of any other cause.

They argue that the cancer treatment at this age – through surgery, radiotherapy and/or chemotherapy – can cause more damage than maintain the tumor.

Brazil

According to Bruno Benigno, urologist at the Oncology and Urology Center of the Alemão Oswaldo Cruz Hospital, the The North American scenario is different from the Brazilian one. “There’s a glut of tests and diagnoses there, but here most men find out about the disease at an advanced stage, so we need to strengthen communication around screening tests, not the other way around,” he says.

In the United States, between 2014 and 2021, the percentage of men at low risk for prostate cancer who chose active surveillance, with screening tests every three to six months, increased from about 27 percent to nearly 60. %. In Brazil, according to the National Cancer Institute (Inca)From 20% of cases of the disease are already diagnosed in an advanced stage due to poor adherence to periodic examinations.

Inca also says that prostate cancer is the most common type of cancer among the Brazilian male population and accounts for 29% of diagnoses of the disease in the country. In 2022, 16,055 men died of the disease, which is approximately 44 deaths per dayaccording to data from the Information System on Mortality of the Ministry of Health.

To change this scenario Benigno argues that it is necessary strengthen prevention campaigns and improve methods of analysis in relation to the clinical condition of patients to determine more precisely when the treatment is or is not beneficial.

After all, when to do prostate exams?

A Brazilian Society of Urology follows the American Society of Urology, which indicates that tests should begin to be done at the age of 45 for all men AND to 40 for those in the risk group. According to Marcelo Wroclawski, president of the company, the the time to stop is when the man has between 5 and 10 years of life expectancy – calculation that must be carried out by the doctor, based on the patient’s lifestyle and general state of health.

Wroclawski says the decision to stop screening when the patient is elderly is due to the awareness that there are not as many benefits of treating cancer in this age group, as well as the risks of biopsies. One of the main ways to detect prostate cancer, biopsies are invasive and carry a risk of infection and bleeding, although some centers now offer safer methods.

The Ministry of Health underlines that “the main recommendation regarding the execution of the tests as a tool for prostate cancer screening is that the medical indication is individualized on a case-by-case basis and shared with the patient, considering the benefits of early diagnosis for treatment options.”

The chart also generally reinforces that imaging methods have a limited role in both the diagnosis and clinical staging of the disease. Therefore, transrectal ultrasound is the method of choice for performing a prostate biopsy, but with the aim of guiding needle placement in different areas of the prostate. MRI is indicated in very select cases. Both methods also have low accuracy in determining the local extent of the disease.

Who is at risk of prostate cancer?

They are in the risk group for prostate cancer and therefore should start monitoring for the disease at age 40, according to the SBU:

• People who were identified as male at birth and have family history of prostate cancer (especially if it was the father or brother who fell ill);
• People who were identified as male at birth and are blackas studies show that the incidence and mortality rate of the disease is higher in blacks;
• People who were identified as male at birth and have BRCA genetic alterationswhich indicates a predisposition to cancer (screening can be done using genetic testing, but is not yet so common in Brazil).

What are the tests that detect prostate cancer?

The exams of rectal exam and blood with collection of Prostate specific antigen (PSA) they are the main ones when prostate cancer is suspected. From suspicion, it can be done biopsies and/or imaging testssuch as CT scans, to confirm the diagnosis of the disease.

When is it worth treating or not?

According to Benigno, the choice whether or not to treat prostate cancer should be made by the doctor, together with the patient and his family, after individual case analysis. “The patient and family need to understand the risks of both treatment and possible tumor progression,” he says.

If the patient’s life expectancy is less than 10 years and the tumor does not appear to be aggressive, not treating it may be better to ensure the best quality of life for this patient at the end of life. If the elderly patient is in excellent health and the cancer is likely to progress rapidly, treatment can guarantee more years of life.

Source: Terra

Ben

Ben Stock is a lifestyle journalist and author at Gossipify. He writes about topics such as health, wellness, travel, food and home decor. He provides practical advice and inspiration to improve well-being, keeps readers up to date with latest lifestyle news and trends, known for his engaging writing style, in-depth analysis and unique perspectives.