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Screening Tools

Prostate Cancer Screening

One man in six will develop prostate cancer. There are no symptoms for early-stage prostate cancer, but it can be detected through screening.  The term screening refers to the regular use of certain examinations or tests in persons who do not have any symptoms of a cancer but are at risk for that cancer. When individuals are at high risk for a type of cancer, this means that they have certain characteristics or exposures, called risk factors, that make them more likely to develop that type of cancer than those who do not have these risk factors.

The American Urological Association says men should have their first screening at age 40. Usually doctors recommend that men repeat the screening annually, but depending on your unique risk factors, your doctor may suggest a different screening schedule. A screening exam consists of a digital rectal exam (DRE) and a blood prostate-specific antigen test (PSA)

Digital Rectal Exam:  A physician inserts a gloved finger into the rectum to assess the texture and size of the prostate. The DRE is the most common prostate screening procedure and has been used for many years; however, whether the test is effective in decreasing the number of deaths from prostate cancer has yet to be determined.

PSA Blood Test: Prostate-specific antigen (PSA) is a protein produced by both cancerous (malignant) and noncancerous (benign) prostate tissue. PSA helps liquefy the semen. A small amount of PSA normally enters the bloodstream. Prostate cancer cells usually make more PSA than do benign cells, causing PSA levels in your blood to rise. But PSA levels can also be elevated in men with enlarged or inflamed prostate glands. Therefore, determining what a high PSA score means can be complicated.

Besides the PSA number itself, your doctor will consider a number of other factors to evaluate your PSA scores:

Should You Get a PSA Test?

Cancer screening tests—including the prostate-specific antigen (PSA) test—can be a good idea. Prostate cancer screening can help identify cancer early on, when treatment is most effective. And a normal PSA test, combined with a digital rectal exam, can help reassure you that it’s unlikely you have prostate cancer. But getting a PSA test for prostate cancer may not be necessary for some men, especially men 75 and older.

Professional organizations vary in their recommendations about which men should get a PSA screening test. While some have definitive guidelines, others leave the decision up to men and their doctors. Organizations that do recommend PSA screening generally encourage the test in men between the ages of 40 and 75 and in men with an increased risk of prostate cancer.

Ultimately, whether you have a PSA test is something you should decide after discussing it with your doctor, considering your risk factors, and weighing your personal preferences.

A Simple Test, A Not-so-simple Decision: Pros and Cons of PSA Screening

Pros of PSA Screening

Cons of PSA Screening

When Elevated PSA Isn’t Cancer

While high PSA levels can be a sign of prostate cancer, a number of conditions other than prostate cancer can cause PSA levels to rise. These other conditions could cause what’s known as a false-positive, meaning a result that falsely indicates you might have prostate cancer when you don’t. Conditions that could lead to an elevated PSA level in men who don’t have prostate cancer include:

False-positives are common. Only about one in four men with a positive PSA test actually has prostate cancer.

When Prostate Cancer Doesn’t Increase PSA

Some prostate cancers, particularly those that grow quickly, may not produce much PSA. In this case, you might have what’s known as a false-negative, or a test result that incorrectly indicates you don’t have prostate cancer when you do. Because of the complexity of these relating factors, it’s important to have a doctor who is experienced in interpreting PSA levels evaluate your situation.

What’s the Advantage of a PSA Test?

Detecting certain types of prostate cancer early can be critical. Elevated PSA results may reveal prostate cancer that’s likely to spread to other parts of your body (metastasize), or they may reveal a quick-growing cancer that’s likely to cause other problems.

Early treatment can help catch the cancer before it becomes life-threatening or causes serious symptoms. In some cases, identifying cancer early means you will need less aggressive treatment, thereby reducing your risk of certain side effects, such as erectile dysfunction and incontinence.

What’s Risky about a PSA Test?

You may wonder how getting a test for prostate cancer could have a downside. After all, there’s little risk involved in the test itself—it simply requires drawing blood for evaluation in a lab.

However, there are some potential dangers once the results are in. These include:

Digital Rectal Exam

The PSA test isn’t the only screening tool for prostate cancer. Digital rectal examination (DRE) is another important way to evaluate the prostate and look for signs of cancer. Your doctor performs the test by inserting a gloved, lubricated finger into your rectum to feel the prostate for bumps or other abnormalities. It’s a quick, safe, and easy test.

Think about Your Risk Factors for Prostate Cancer

Knowing the risk factors for prostate cancer can help you determine if and when you want to begin prostate cancer screening. The main risk factors include:

Consider the Varying Viewpoints: What are the Recommendations?

American Urological Association (AUA)

American Cancer Society (ACS)

Centers for Disease Control and Prevention (CDC)

U.S. Preventive Services Task Force (USPSTF)

American College of Preventive Medicine (ACPM)

How Does it Add Up?

A positive PSA test can be a lifesaver for some men, identifying prostate cancer that needs treatment early. It’s generally a good idea to undergo PSA testing if you’re at increased risk of prostate cancer. However, not all men need to have the screening. You may want to think twice if you’re in a group of men unlikely to benefit from it. After considering the pros and cons of screening, your age, general health, risk factors, your preferences, and what the experts say, talk to your doctor. Together you can make the right decision for you.

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