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Scott Webb: As men get older, it's important that we get regular physicals and are screened for prostate cancer. In light of the new prostate screening guidelines, it's a great time to have on Dr. James Siegert. He's a board-certified neurological surgeon practicing with Specialty Physicians of Illinois and Franciscan Health Olympia Fields where he's the Urology Residency Program Director and Chairman of the Department of Surgery.

This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, I really appreciate your time today. Let's talk about the new prostate cancer screening guidelines. What do they mean for people?

Dr. James Siegert: The area of prostate cancer screening has been a somewhat controversial and confusing one for patients and practitioners alike, but the newer guidelines provide a new level of evidence and guidance as far as who should be screened and when they should start screening.

Scott Webb: Yeah. So let's go through that doctor, who should be screened?

Dr. James Siegert: The ideal person to be screened as the person that understands what the test involves, the test being PSA, which stands for prostate-specific antigen and also the person that may carry some risk factors. And so the risk factors for prostate cancer are advancing in age, uh, typically above the age of 55, as well as, uh, the respecters of African-American ethnicity and a family history involving a dad or brother of prostate cancer.

Scott Webb: And you mentioned age in there, but when exactly should people begin to be screened?

Dr. James Siegert: Typically, the greatest benefit with screening that's been shown in multiple trials and it's endorsed by most guidelines is between the age of 55 to 70, uh, provided that the person is in reasonably good health and understands some of the limitations associated with the screening. But we do move up a screening to as early as age 40, uh, according to some guidelines, including the American Urological Association in men who have risk factors, such as African-American ethnicity or a family history.

Scott Webb: So let's talk about some of the disparities in the US, uh, when it comes to the population and prostate cancer, especially with African-Americans.

Dr. James Siegert: So prostate cancer is the most common cancer diagnosed in men in the United States with an estimated 200,000 men that will be diagnosed in 2020 alone. There's fortunately a wide gap between the men that are diagnosed and men that die of prostate cancer with an estimated 30,000 men that die of prostate cancer every year. But prostate cancer is common as it affects about one in nine men in the United States. Uh, that risk is nearly doubled to about one in five, if you're of African-American ethnicity or if you've had a family history of prostate cancer. That risk goes up especially amongst those with a family history of prostate cancer in which the relative was diagnosed at a very early age or late stage.

Scott Webb: And doctor, do we know why African-Americans are at greater risk?

Dr. James Siegert: No. We do know that the tumor biology of the disease itself behaves much more aggressively and that even controlling stage for stage, uh, in diagnosing men, uh, of African-American and, and non-African-American ethnicities, African-Americans are twice as likely to be diagnosed with and also twice as likely to die of prostate cancer. So there's something on both genetic and molecular and biologic basis that this disease tends to behave much, much more aggressively.

Scott Webb: And doctor, we're going to talk about MRIs in a bit, but how do you typically screen for prostate cancer?

Dr. James Siegert: So prostate cancer screening is generally done with a physical exam, which is the digital rectal exam. And what we're assessing for is the size of the prostate, as well as areas of firmness of the prostate that may indicate a cancer. Typically, the prostate feels like the tip of your nose. Um, if it feels very firm like your cheekbone, that's obviously concerning for cancer. But the mainstay of screening is a PSA blood test, again, which stands for prostate-specific antigen. And it's testing a protein that is made within the prostate and excreted by the prostate, uh, that at high levels may indicate an increased risk of prostate cancer.

Scott Webb: So let's talk about MRIs, what's their role in detecting prostate cancer?

Dr. James Siegert: So good question. The role of prostate MRI as a detection tool or as a screening tool is still being defined on a seemingly daily basis. The primary use of MRI within prostate cancer detection is within men that have already been diagnosed with prostate cancer in the United States as part of active surveillance in which they're opting to forgo treatment in favor of closely watching their disease. And this is one of the tools that we use.

The secondary use of MRI is in a man who has a high index of suspicion, such as a rising PSA after a previously negative biopsy, a family history, uh, of prostate cancer in which, uh, we use the MRI to tell us if there's any areas of concern. Uh, that concern being a more aggressive form of prostate cancer that we can then target.

Um, where the future role of MRI is yet to be defined, uh, at least in this country it is in a screening population to largely replace PSA screening. Uh, there are some centers and some patients that opt to undergo that, uh, and that the MRI is better able to detect areas of greater concern for prostate cancer than just simply PSA alone.

Scott Webb: So doctor, as we get close to wrapping up here today, anything else you want to tell people about, uh, screening for prostate cancer? Who, when, how, all that good stuff?

Dr. James Siegert: Yeah, so I think the key thing is PSA testing is something that every man should talk to his primary care physician about, but realizing there are some limitations that PSA testing is not a binary test or black and white positive or negative test. It's much like blood pressure and the higher the blood pressure, the higher the risk of developing a heart attack or stroke. The higher the PSA, the higher the risk of developing prostate cancer, especially the more aggressive type.

But realize that there is no PSA test above which we would say that you have prostate cancer or below which you're safe from ever developing prostate cancer. But also realize that generally in the case of PSA testing, it best suits those who are at risk, those who have a family history, those of us of an African-American ethnicity. And those are the reasonably long-life expectancy, generally, at least 10 years given the generally slow-growing nature of prostate cancer. So I would encourage every man above the age of 40 or certainly with those at risk who haven't been tested to have an informed discussion with his primary care doctor on the risks and benefits and alternatives of a screening testing.

Scott Webb: And that's where this typically starts, right, with our primaries?

Dr. James Siegert: Yeah. I mean, most men generally don't present to a urologist or an oncologist for prostate cancer screening. Uh, they present to the urologist after they've been told their PSA number is high. Uh, but generally most screening, whether it be colonoscopy for colon cancer, mammography for breast cancer or chest x-rays or chest CTs for lung cancer in United States is ordered and performed by the primary care. Um, so I would encourage all men to speak to their primary care doctor about this.

Scott Webb: Yeah. And I know that during the pandemic that telehealth and virtual visits have become very popular. So if people aren't comfortable going in to see their primaries, maybe they can get the ball rolling, get the conversation started about prostate cancer by doing a virtual visit.

Dr. James Siegert: Yeah. That's exactly right. This discussion of prostate cancer risk and risk screening can largely be entirely done remotely or virtually. Uh, there's really no in-person exam that's necessary. There's no qualifications beyond, uh, what I've mentioned above a certain age or certain risk factors present and a desire to be screened. And so the suits itself very well, uh, for screening with just a simple blood test that could be done at any lab.

Scott Webb: Yeah. And as you said, doctor, we have to know our risk factors, want to be screened, reach out to our primaries and so on. Doctor, thanks so much for your time and expertise today and you stay well.

Dr. James Siegert: You too. Thanks so much.

Scott Webb: For more information on the new prostate screening guidelines, visit spidocs.org search urology. And we hope you found this podcast to be helpful and informative. This is the Franciscan Health Doc Pod. I'm Scott Webb. Thanks for listening.