Screening High-Risk Men in Their Forties
by William J. Catalona, M.D.
African-American men and men with a family history of prostate cancer (particularly those with an affected brother or father) are at higher risk to develop prostate cancer.
In high-risk patients, prostate cancer tends to occur at a younger age. Therefore, to decrease prostate cancer deaths in high-risk men, it is necessary to detect the cancer at an earlier age.
The American Cancer Society recommends offering screening for prostate cancer to men in the general population beginning at age 50. However, in high-risk men, screening is recommended beginning at age 45, and in men with early age of onset prostate cancer in their family, screening should be considered beginning at age 40.
Virtually, no published information exists on the results of screening high-risk men in their forties. According to the US national tumor registry, in the general population the chances of being diagnosed with prostate cancer from birth to age 39 is 1 in 10,000, from age 40 to 59 it is 1 in 49 (2%), from age 60 to 79 it is 1 in 7 (13%).
Dr. Catalona's research team recently presented data from the PSA study on 664 high-risk men (358 African American, 276 family history, 30 both African American and family history) who were screened for prostate cancer in their forties.
Of these men, about 6% had abnormal screening tests (elevated PSA, suspicious digital examination or both) and were recommended to have a prostatic biopsy.
Of those who underwent the recommended biopsy, more than half had cancer diagnosed. Thus, the prevalence of prostate cancer in this age group was 3.8%, nearly double that anticipated in the general population.
Of the cancers detected, more than 80% were totally contained within the prostate gland and thus curable. Most of the remaining 20% had barely invaded the capsule of the prostate gland or minimally extended into the surrounding tissues and thus were also potentially curable.
The results show that few high-risk men have abnormal screening results, but of those who do, more than half will be found to have potentially curable prostate cancer.
Screening high-risk men in their forties likely helps reduce the death rate from prostate cancer in this vulnerable population.