(Editor’s note: A new feature, Second Opinion, will occasionally ask Twin Cities doctors to elaborate on health news.) 

The case: Let’s say a 76-year-old man is worried about prostate cancer and goes to his doctor for a routine screening test. If you were his doctor, what would you tell him, in light of Monday’s recommendation from the U.S. Preventive Services Task Force that doctors should stop doing those tests on men 75 or older?

Today’s doctor: Dr. Daniel Zapzalka, a urologist at Park Nicollet Clinic in St. Louis Park.

“I think it’s actually not too far from what people, urologists, have been recommending for a long time,” Zapzalka said. “For years I’ve been recommending after around 80ish to stop checking PSAs (prostate-specific antigens, the test for prostate cancer).”
Why? By the time a man reaches his late 70s or early 80s, there’s little chance, statistically speaking, that prostate cancer will cut his life short. Meanwhile, the treatment — from biopsies to surgery — can cause infections, impotence and incontinence.
“This is one area where you can easily get caught in where the treatment is worse than the disease…. What I tell these guys…when they’re around 80, don’t let anybody check your PSA anymore unless you develop any new urinary symptoms, such as difficulty urinating or blood in your urine.”

 Usually, they’re happy to hear it. “Most men are pretty realistic. Most of them say, sounds good to me,” Zapzalka said.
Of course, if they have symptoms, they should “absolutely” check them out, he added. The debate is about routine screening for cancer, not about treatment.

Exception to the rule: If someone is unusually active and healthy, Zapzalka might give the test past age 75. Also, if someone insists, “I say, well this is America, you have that right.”

Who should get routine tests for prostate cancer?  Men 50 and older, or 40 and older if they have a family history of prostate cancer.

For more information:
• U.S. Preventive Services Task Force report on prostate cancer screening
• The National Cancer Institute