Follow the Research, Follow the Guidelines

Changes in both Prostate Cancer Options and Breast Cancer Screening Recommendations

Photo by Hacı Elmas on Unsplash

Major changes have been recommended related to screening and treatment for two of our most common cancers. Men with early, local prostate cancer can now opt for active surveillance instead of aggressive treatment, and the age for screening mammograms has been rolled back to 40 from a relative recent recommendation of 50. Let’s review each of these findings, which are pertinent to so many of us and our loved ones.

The American Urological Association review of prostate cancer is clear: if you are diagnosed with localized prostate cancer you will not increase your survival rate with surgical removal of the prostate or radiation to the area compared with “active surveillance” with laboratory testing including PSA, imaging, and repeat prostate biopsy at suggested interludes.

Both prostate cancer and its treatment carry risks. Side effects of conventional care often impact overall energy, vitality, and cognition, may also cause all manner of challenges related to urinary, sexual, and bowel function. I have seen in my decades-long practice the way such cancer treatments impact quality of life. When your urologist or urologic oncologist is helping you understand your specific risks, it should be done in context of your current life expectancy, other ailments you have, genetics, and more. The key take-away here is that for those with localized (meaning the cancer has not spread,) and smaller cancers, active surveillance is now the standard of care.

I appreciate that people are rightfully afraid of cancer and when they learn they have it, it’s common to say, “take it out.” And fast! But the meta-analysis of the studies that have looked at the various paths does not point to that as the superior option, even if you might feel you are buying peace of mind.

Mammograms guidelines changed in 2009, raising the age of starting biennial scans to age 50. But due to the startling rise in breast cancer among women under 40 and the mortality from breast cancer in black women, the US Preventive Services Task Force, in a preliminary report, has rolled the age to begin screening back to 40. In addition they are urging more research in…