Kaiser Permanente Northern California is urging all men ages 50 to 69 to speak to their doctors about prostate cancer screening, following a dramatic rise in advanced cases nationally.

Those in high-risk groups — men with a family history and Black men ages 45 to 69 — should not delay the conversation about screening options, said Joseph Presti, MD, surgical lead for Urologic Oncology for Kaiser Permanente Northern California.

Prostate cancer is the second leading cause of cancer deaths among men, behind lung cancer, in the United States. The prostate is a walnut-shaped organ that produces seminal fluid, located just below the bladder.

“If you fall into 1 of those 2 categories, you should speak with your primary care doctor about the pros and cons of screening and decide what’s best for you,” said Dr. Presti. “If you have a family history of prostate cancer with a first-degree relative such as a father or brother who was diagnosed before age 65 or had metastatic disease when diagnosed, that conversation is even more important.”

Kaiser Permanente began mailing targeted reminders last fall urging men to have the conversation. Primary care physicians will soon receive an electronic reminder to speak with patients during visits. And an online tool is in the works to educate members about prostate cancer with an option to schedule a test, said Dr. Presti.

“We looked at the data and saw room for improvement, and we are acting on it and implementing changes,” he said, referring to the new outreach and online tool.

The renewed emphasis on prostate cancer education and screening comes as data from a national study showed a 41% increase in metastatic prostate cancer in men ages 45 to 75 from 2010 to 2018.

And a separate study by Kaiser Permanente Northern California researchers, including Dr. Presti, that examined prostate cancer data along racial lines from 2012 to 2017, found a significant increase in advanced cancer that was greatest in Black men, followed by white men, then Asian men.

“It is well established that prostate cancer incidence and mortality vary as a function of race, but we’re not exactly sure why,” said Dr. Presti.

Screening fell, then cancer rose

Both studies found the increases in prostate cancer numbers began in 2012 when the U.S. Preventive Services Task Force recommended primary care physicians stop offering the screening for all men. That decision was made because prostate cancer test results sometimes led to overtreatment of slow growing cancers that left men leaking urine and unable to achieve an erection, not to mention psychological damage from receiving a cancer diagnosis, even if it was not life threatening.

“The prostate cancer screening test is not perfect,” said Dr. Presti. “If you look at men who have mildly elevated test levels, only about a quarter of those require treatment. That said, I am still a big advocate of men having that conversation with their doctors about testing. We are currently looking at better ways to identify men with elevated PSA levels that need a biopsy.”

9