New data published by the American Cancer Society is clear and alarming: More men were diagnosed with advanced prostate cancer and fewer men were diagnosed in early stages of the disease during the five-year period after the U.S. Preventive Services Task Force (USPSTF) in 2012 stopped recommending that all men over age 50 get an annual prostate specific antigen (PSA) test to screen for early signs of the disease. The PSA test is a blood test that is approved by the U.S. Food and Drug Administration — when given in conjunction with a digital rectal exam — as a screening tool to look for early signs of prostate cancer in men age 50 or older. PSA levels are often elevated in men with prostate cancer, so this test can detect early disease in people with no symptoms. While prostate cancer experts acknowledge it’s an imperfect tool, it remains critical for identifying people who might be at increased risk for the disease so they can be monitored differently than people with average risk. “PSA testing has been used for nearly three decades successfully to reduce the number of prostate cancer-related deaths through early detection and monitoring of advanced disease recurrence. There is no question this tool will continue to save lives through early detection if we use it properly to screen men over age 50. Unfortunately, often by the time a man has prostate cancer symptoms, the disease has spread. Early detection is critical, and we have a tool that can help us do that,” says Ahmad Shabsigh, MD, a urologic oncologist and surgeon at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James). In 2008, the USPSTF recommended against using prostate specific antigen for prostate cancer screening for all men over 75 years. The screening guidelines shifted in 2012 when the USPSTF recommended against using PSA to screen for prostate cancer in all men irrespective of age. In 2018, the USPSTF made its current recommendation of individual decision-making for men 55 to 69 and no screening recommendations for men over age 70. Edmund Folefac, MB/CHB, a medical oncologist specializing in prostate cancer at the OSUCCC – James, says this is the wrong approach and will result in greater cancer health disparities and patients being diagnosed with advanced-stage, less treatable disease. Folefac notes there are many excellent providers in the community offering advice on cancer screening to their patients, but he expresses concern that, without receiving clear guidance on benefits of screening, many patients will skip the screening test out of fear about test results or out-of-pocket insurance costs. “When prostate cancer is caught in its earliest stages, the disease has nearly a 100% cure rate at five years post-treatment,” Folefac says. “But with stage 4 disease, a patient’s chance of surviving five years with the disease goes down to 30%. We must do better, and screening is the first critical step.” Folefac and Shabsigh agree that any man with a family history of prostate cancer or related cancers, and all African-American men, should have a baseline PSA test at age 45. They also point out that oncologists can help better determine who is at increased risk for prostate cancer death and which patients are likely to have more aggressive disease with the aid of: Active surveillance, which does not require immediate treatment of the cancer but may involve repeat biopsies or other testing, with treatment becoming an option only when the cancer appears to become more aggressive; A “watch and wait” approach for slow-progression cancers in certain patients; The use of better imaging tools and genomics that enable oncologists to understand the behavior and molecular characteristics of individual tumors. “This is where the individual decisions come into play, but PSA testing in all men over age 50 as a benchmarking tool is a critical first step,” Folefac says. To learn more about prostate cancer treatment and research at the OSUCCC – James, visit cancer.osu.edu.