Q&A: Prostate cancer screening misconceptions common but combatable

Key takeaways:

• Most men surveyed thought the first step to screening was a rectal exam rather than a blood test.
• Physicians can work to correct misconceptions and ensure their patients are getting recommended screenings.

Primary care providers should discuss prostate cancer screening with eligible patients and work to dispel common misconceptions that keep men from getting screened, according to an expert.

The American Cancer Society (ACS) recently published a survey regarding the common misconceptions surrounding prostate cancer screening among men in the United States.

Partially because of the reported misunderstandings, roughly two-thirds of men aged 55 to 69 years are not being screened for prostate cancer, according to a press release from the ACS. After decades of decreases, the rate of advanced-stage prostate cancer diagnoses has now increased.

Healio spoke with William L. Dahut, MD, chief scientific officer for the ACS, to discuss the most important facts and figures from the report and what PCPs can do to address gaps in screening.

Healio: Will you discuss the importance of prostate cancer screening education?

Dahut: There is an alarming trend of prostate cancer incidence in the U.S., with the number of patients being diagnosed with advanced-stage prostate cancer now increasing after decades of decline. This year, according to the ACS Cancer Facts & Figures report, almost 300,000 men will be diagnosed with prostate cancer in the U.S., and more than 35,000 men will die from the disease. To address this troubling trend, it is critical that we ensure men are educated on prostate cancer screening guidelines to catch the disease early before signs or symptoms develop.

Healio: What are the most common misconceptions people have about prostate cancer screening?

Dahut: In a survey of nearly 1,200 men aged 45 years and older in the U.S., the ACS released findings that highlighted common misconceptions related to prostate cancer screening. These include:

• Three in five men, or 60%, mistakenly believed that the first step to prostate cancer screening is a rectal exam performed by a health care provider, as opposed to a blood test for levels of prostate specific antigen.
• Among men who had not been screened for prostate cancer, the No. 1 reason they gave was that they don’t think they need to be screened for prostate cancer yet (37%).
• Two in five U.S. men (38%) did not know that family history of prostate cancer influences eligibility for prostate cancer screening.
• One in four Hispanic men and one in four Black men were unsure or mistakenly believed they don’t need to be screened for prostate cancer unless they experience potential signs or symptoms of the disease.
• Over half of men, or 56%, didn't know that erectile dysfunction can be a sign of prostate cancer.

Healio: How do these misconceptions affect patients and outcomes?

Dahut: Common misconceptions about prostate cancer screening have likely led to an increase in advanced-stage prostate cancer diagnoses, and worsened patient outcomes as a result of late-stage diagnoses. Once prostate cancer advances and spreads beyond the prostate, it becomes difficult to treat, significantly decreasing the patient’s survival rate.

Healio: How can PCPs correct these misconceptions?

Dahut: Health care providers should have regular discussions with their patients about prostate cancer screening as early as age 40 years, depending on their risk level. Discussion about prostate cancer screening should take place at:

• age 50 years for men who are at average risk for prostate cancer, meaning that they don’t have a family history of prostate cancer or other factors;
• age 45 years for men at high risk for developing prostate cancer. This includes Black/African American men and men who have had a first-degree relative, such as father or brother, diagnosed with prostate cancer at age 65 years or younger; and
• age 40 years for men at even higher risk; for example, those with more than one first-degree relative who had prostate cancer at an early age.

Healio: The survey additionally highlighted health inequities , including that the incidence of prostate cancer is 70% higher in Black men than white men. What can PCPs do to address these disparities?

Dahut: To address the disparities, health care providers can make sure that all patients — regardless of race, age, ethnicity — are equipped with necessary resources and support through cancer treatment. For example, the ACS provides access to treatment through our Road to Recovery program and Hope Lodge communities, ensuring that anyone who needs a ride or a place to stay during treatment has one free of charge. PCPs can also ensure that all patients are educated on the latest prostate cancer screening guidelines and encourage patients to get screened if they fit the criteria, especially for African American men who may be at higher risk.

Healio: What is the take-home message for PCPs here?

Dahut: We urge providers to educate their patients about prostate cancer screening and the importance of early detection and prevention strategies. For individuals who undergo regular screening, we have the potential to save lives and address the increase in late-stage prostate cancer diagnoses.

Healio: Is there anything else you would like to add?

Dahut: In addition to the known racial disparities among Black men, there are now higher rates of advanced prostate cancer among Latino men and American Indian/Native American men. ACS has launched a larger initiative, IMPACT, which is aimed at addressing these disparities and to reduce prostate cancer mortality for all.

References:

• American Cancer Society recommendations for prostate cancer early detection. https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/acs-recommendations.html. Accessed Nov. 20, 2024.
• Cancer facts and figures. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2024/2024-cancer-facts-and-figures-acs.pdf. Accessed Nov. 20, 2024.
• Rectal exam or blood test? 60% of U.S. men ages 45+ have misconceptions about prostate cancer screening, as rates of late-stage diagnosis increase. https://pressroom.cancer.org/releases?item=1347. Accessed Nov. 20, 2024.
• Road to recovery. https://www.cancer.org/support-programs-and-services/road-to-recovery.html. Accessed Nov. 20, 2024.