Prostate Cancer Screening in Men with Down Syndrome

Key Points on Prostate Cancer

• Prostate cancer is one of the most common types of cancer in men.

• There is uncertainty about the potential benefits and risks of prostate cancer screening for men. 

• Some medical organizations do not recommend any screening for prostate cancer in men. Other organizations recommend considering screening based on age and risk factors. 

• Since prostate cancer is often slow-growing, screening may not be beneficial for men who are expected to live fewer than 10-15 additional years.

• Medical organizations recommend that men should discuss screening with their health care provider to make a decision that is appropriate for their circumstances.

 

Key Points on Down Syndrome and Prostate Cancer

• Prostate cancer is uncommon in men with Down syndrome.

• If a screening test is abnormal, men with Down syndrome are more likely to require general anesthesia to complete the follow-up testing. Anesthesia increases the overall risk of screening.

• An abnormal screening test is likely to be a “false positive” because prostate cancer is uncommon in men with Down syndrome. A false positive is when there is an abnormal test result, but the man does not have prostate cancer. It is likely that most men with Down syndrome who have an abnormal screening test will have normal follow-up testing.

• Prostate cancer screening recommendations begin at age 50-55 (age dependent on the organization making the recommendation) for men who are at average risk of prostate cancer. Life expectancy of people with Down syndrome is about 60 years. Depending on the age of the man with Down syndrome, screening may not be beneficial if he is not expected to live an additional 10-15 years.

• We recommend discussing the risks and benefits of prostate cancer screening with men with Down syndrome and their families. For men with Down syndrome, the benefit of prostate cancer screening is likely to be quite low and the risk greater. However, the effects of risk factors for prostate cancer (age, race, etc.) are not known for men with Down syndrome. 

 

What is prostate cancer?

The prostate is a gland that is located just below the bladder in men. The primary function of the prostate is to make fluid for sperm. Cancer of the prostate is one of the most common cancers in men. Many prostate cancers grow slowly but some grow more rapidly. 

Prostate cancer is uncommon in men with Down syndrome. We are not aware of a single case of prostate cancer in over 3,000 men with Down syndrome seen at our Center over 32 years. 

More information on prostate cancer is available on the Mayo Clinic website .

 

What are risk factors for prostate cancer?

• Older age

• African American race

• Family history of prostate cancer

• Diets high in fat

• Low vegetable consumption

• Cigarette smoking contributes to a higher risk of dying from prostate cancer

 

What screening can be done for prostate cancer?

• A physical exam in which the examiner inserts a finger into the man's anus to feel the prostate and assess for any abnormalities (digital rectal exam).

• A blood test, called the prostate specific antigen (PSA), measures a substance made by the prostate. The value increases when a man has prostate cancer. It can also increase in some other conditions. The test is usually repeated after a period of time to assess whether it remains abnormal.

More information on prostate cancer screening is available on the Centers for Disease Control and Prevention (CDC) website .

 

What are the next steps if one of the screening tests is abnormal?

One or more additional tests may be done: 

• An ultrasound can assess the prostate. A small probe is inserted into the rectum. Sound waves from the probe create a picture of the prostate gland.

• Magnetic resonance imaging (MRI) can be done to get a more detailed picture of the prostate.

• A biopsy of the prostate can be done to assess for prostate cancer cells. An instrument is placed into the rectum and a needle is inserted into the prostate through the rectal (large intestine) wall.

For all these tests, men with Down syndrome are more likely to require general anesthesia to allow them to be performed. The use of general anesthesia increases the risk of the procedures.

 

What are the current prostate cancer screening recommendations (for men without Down syndrome)?

There are variations in the screening recommendations depending on the organization. 

The United States Preventive Services Task Force  (USPSTF) recommends: 

• For men aged 55 to 69 years, physicians should inform patients about the harms and benefits of PSA testing. The decision to undergo screening should be an individual one based on the discussion of the harms and benefits as well as the patient's values and preferences. 

• Only men who express a clear preference for screening should be tested.

• Prostate cancer screening should not be performed in men older than 70 years.

The American College of Physicians  (ACP) states that, "Doctors should not screen using PSA in average-risk men younger than 50 years or older than 69 years, or any man with a life expectancy less than 10 to 15 years."

The American Cancer Society  (ACS) recommends considering PSA testing starting at age 50 (younger in those at higher risk) after discussing the uncertainties, risks, and potential benefits of prostate cancer screening.

 

What are the prostate cancer screening recommendations for men with Down syndrome?

Currently, there are not recommendations specific for men with Down syndrome. The next edition of the GLOBAL Medical Care Guidelines for Adults with Down Syndrome is in progress. It will include a recommendation regarding prostate cancer screening for men with Down syndrome. 

We recommend discussing the risks and benefits of prostate cancer screening with men with Down syndrome and their families. For men with Down syndrome, the benefit of prostate cancer screening is likely to be quite low and the risk greater. However, the effects of risk factors for prostate cancer (age, race, etc.) are not known for men with Down syndrome.