​​​​​​​​​​​​​​​​September is Prostate Cancer Awareness Month. One of the keys to finding prostate cancer early to improve the chance of successful treatment is getting a regular check with your physician. We all have that one man in our life who just seems to not go to the doctor or put their health first. For me, it’s my dad. When he’s sick, I always have to push him to go to the doctor, to put his health first and to make sure he is going for regular check-ups.

I often talk about regular check-ups with my coworkers and even brought up this blog topic of prostate cancer. I told the guys, “You know September is Prostate Cancer Awareness Month. When was the last time you had a physical exam?” I was so surprised to learn that a few of my male coworkers hadn’t had a check-up since 2019. They could be at-risk for so many things! I’ve asked them to check out this interview with Dr. Christopher Freese, a radiation oncologist at The Christ Hospital, about screenings, prevention and prostate cancer.

Recommended guidelines for prostate screenings

When it comes to prostate screenings and when they should start, there are recommended guidelines, but it really depends on the risk.

Dr. Freese said, “The guidelines recommend shared decision-making for most average risk males reviewing the potential benefits as well as possible harms. Patients with average risk who decide on screening (per NCCN Guidelines) are recommended to begin blood-drawn PSA (prostate-specific antigen) testing at 45 to 75 years of age, repeating every 1–2-yearss with consideration of a digital rectal exam (DRE.) If higher risk (African American, known genetic mutation or family history), NCCN recommends starting at age 40.”

Are you at risk?

So, how do you know you’re at higher risk? I’m sure most of us think that family history plays a big part of it.

Dr. Freese added, “Studies report that African American may be at higher risk as they develop prostate cancer at a younger age and with a higher incidence. Patients with a family history of prostate cancer, especially if a first-degree relative was diagnosed earlier than 65, are also at higher risk compared to the general population. Additionally, patients with a family history of breast cancer, colorectal cancer, ovarian cancer, or pancreatic cancer should be evaluated. Lastly, patients with known genetic mutations including BRCA1, BRCA2, ATM, CHECK2, TP53 or Lynch Syndrome (MLH) are at higher risk.

Get started with a phone call

The routine exam for of checking the prostate begins with a phone call to your doctor. Just make an appointment for a physical exam. It sounds easy.

Dr. Freese said, “Often patients will get a PSA and if shown to be elevated they will be sent to the urologist for evaluation. A rectal exam may also be performed by your provider.

Risks and benefits

I asked Dr. Freese, “What are the risks and benefits to screening for prostate cancer?” His answer made me laugh, because he responded with one of my favorite answers—"How much time do you have, and it depends on who you ask.” LOL!

“The challenge is that prostate cancer is very common and the risk of developing prostate cancer increases with age (picture below showing the incidence of occult prostate cancer based off autopsy studies [per UpToDate​]). When the PSA test was developed there was a rapid increase in the incidence of prostate cancer diagnosis as you would expect given how common it is in older men. Many of these men were treated but at that time it was difficult to determine if they benefited from therapy. Various clinical trials have been performed attempting to clarify the benefits of prostate cancer screening but unfortunately these studies have shown conflicting results which complicates the discussion. The concern is with the overdiagnosis of clinically insignificant cancers (cancers which would not limit a patient’s life). These patients are still subjected to diagnostic testing and potential treatment side effects. As a result of this confusion, guidelines now recommend a shared decision-making process with primary care providers to review the benefits and harms of screening in patients of average risk.

• 20 to 30 years, 2 to 8 percent of men with occult cancer

• 31 to 40 years, 9 to 31 percent

• 41 to 50 years, 3 to 43 percent

• 51 to 60 years, 5 to 46 percent

• 61 to 70 years, 14 to 70 percent

• 71 to 80 years, 31 to 83 percent

• 81 to 90 years, 40 to 73 percent

Take care of yourself today

Now that we know the risks and benefits of getting the prostate cancer screening, Dr. Freese said that there are some things you could do to lower the risk of getting prostate cancer. “Studies have shown that smoking and obesity may increase the risk of prostate cancer. By eating well and maintaining a healthy lifestyle you can reduce your risk of prostate cancer. “

He also suggested living a healthier lifestyle is key to overall good health. He suggested, “By taking care of yourself today, you will live a better and more fulfilled life in the future. It is impossible to count the number of times we talk to patients who kick themselves for not taking better care of themselves when they are younger as it can make life very difficult when they are older.”