Monday Medical: Clearing up PSA confusion |

Monday Medical: Clearing up PSA confusion

Susan Cunningham/For Steamboat Today

If you're confused about when or if to get a prostate screening, you're not alone.

"There's a lot of controversy over the PSA as a screening test," said Dr. Clay Pendleton, urologic surgeon in Steamboat Springs. "Some organizations feel, historically, prostate cancer has been overtreated."

But screenings can be important: One in seven men will be diagnosed with prostate cancer during their lives, and prostate cancer — once it's found — is usually treatable. Also, in almost every case, there are no symptoms or signs of the cancer.

"There are no real warning signs or symptoms until a very late stage," Pendleton said.

Pendleton follows the screening recommendations of the American Urological Association, which are generally to screen men ages 40 to 54 who are considered high-risk — for instance, men who have a family history of the disease or are African Americans — as well as to screen all men ages 55 to 69 every year.

For men ages 55 to 70 who are at very low risk for the disease, screenings can be extended to every two years. And for men in good health, screenings may continue past age 70.

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Pendleton strongly recommends knowing your family history.

"I know several young men with prostate cancer, and they didn't know that their father and two uncles had prostate cancer," he said. "I think it's not talked about."

The prostate gland, which sits below the bladder and in front of the rectum, makes fluid that helps protect and nourish sperm cells in semen. The prostate, which grows with age, can sometimes press on the urethra and causes issues with urination. That issue, which is not cancer, can be treated with medication or surgery.

To detect prostate cancer early, men can be tested at their primary care clinic or urology clinic. Screening involves a prostate-specific antigen blood test to check for elevated levels of PSA in the blood and a rectal exam to check for nodules or hard areas on the prostate.

If cancer is suspected, a biopsy on the prostate is performed. For low-risk cancer, many patients choose to undergo active surveillance, though some cases may be treated. Intermediate and high-risk cancers are usually treated.

There are various treatment options, including surgical removal of the prostate gland, which Pendleton often does as minimally invasive robotic surgery, or killing cancerous cells in the prostate through radiation, inserting radioactive seeds or freezing the tissue.

"There's a very high success rate, especially with low- and intermediate-risk prostate cancer," Pendleton said.

For younger men, a fairly common issue is a solid tumor cancer in the testes, which presents as a painless, firm nodule. In some cases, it is discovered after a trauma, such as being kicked in the groin during a sports game.

"It's something that's very treatable," Pendleton said. The testicle and spermatic cord are removed, and if the cancer has spread, there may be a need for chemotherapy, radiation and further surgery.

Pendleton, who worked at the MD Anderson Cancer Center before coming to Steamboat, said that, overall, the community here does a good job of staying on top of issues such as prostate cancer.

"The primary care physicians are strong in Steamboat and do a good job of screening. We have a very educated patient population that are more in tune with their health," Pendleton said.

And the best news is that when prostate cancer is found, "it's something that can be dealt with, even at the more advance stages," he said.

Susan Cunningham writes for Yampa Valley Medical Center. She can be reached at

Prostate screening recommendations from the American Urological Association

• Recommend against PSA screening in men younger than.

• Recommend against routine screening of men ages 40 to 54 at average risk. Screen as needed for men younger than 55 at a higher risk, for instance, men with a family history of prostate cancer or of the African American race.

• Men ages 55 to 69 should work with their providers to consider screening based on their PSA values and preferences, which usually involves screening every year or every two years.

• Does not recommend routine screening in men ages 70 or older or those with a life expectancy less than a 10 to 15 years.

If you go

What: Know Your Score — A talk with Dr. Clay Pendleton to update your prostate playbook

When: Noon to 1 p.m. Monday, Nov. 9

Where: Conference Rooms at Yampa Valley Medical Center

Information: Lunch will be served. RSVP is required at