Prostate cancer screening

The American Cancer Society, the American Urological Association, and the National Comprehensive Cancer Network do believe that the majority of available evidence, though not conclusive, supports the view that prostate cancer screening can save lives. These organizations recommend that health care providers offer men 50 years or older the option of testing for early detection of prostate cancer. They also recommend discussing the potential benefits, side effects, and questions regarding early prostate cancer detection and treatment, so that men can make informed decisions about testing.

Screening Tests

PSA (Prostate-Specific Antigen) Blood Test
(Age/Frequency: 50+/annually)

This simple blood test measures prostate-specific antigens, proteins made by prostate cells, and can be accomplished in your physician's office. PSA blood test results are reported as nanograms per milliliter or ng/ml. Results under 4ng/ml are usually considered normal. Results over 10ng/ml are high and values between 4 and 10 are considered borderline. The higher the PSA level, the more likely the presence of prostate cancer.

It is important to understand how the PSA blood test is used in early detection of prostate cancer. PSA levels estimate how likely a man is to have prostate cancer, but the test does not provide a definite answer. Conditions such as benign prostatic hyperplasia (noncancerous prostate enlargement) and prostatitis (inflammation of the prostate) can cause a borderline or high PSA result.

On the other hand, some men with prostate cancer have negative or borderline PSA results. Certain measures are recommended by many doctors to make PSA testing as accurate as possible. Because ejaculation can cause a temporary increase in blood PSA levels, some doctors suggest that men abstain from sexual activity for two days before testing. Several medications and herbal preparations can lower blood PSA levels. Men having the PSA blood test should tell their doctors if they are taking finasteride (Proscar or Propecia), saw palmetto (an herb used by some men to treat benign prostate enlargement), or PC-SPES (an herbal mixture that contains saw palmetto).

Although the PSA blood test is not perfect, it is the best test currently available for early detection of prostate cancer. Since doctors started using this test, the number of prostate cancers found at an early, curable stage has increased. And since most men have normal test results, they can be reassured that they are unlikely to have prostate cancer, especially if their digital rectal exam (DRE) result is also negative.

Men with a high PSA result are advised to have a biopsy, to find out whether or not cancer is present. Test results in the borderline range may cause some confusion. If the DRE result is abnormal, a biopsy is recommended regardless of the PSA levels.

Although the PSA test is used mainly for early detection, it has value in other situations. In men known to have prostate cancer (based on their biopsy result), the PSA test can help predict prognosis (outlook). Men with very high PSA results are more likely to have cancer that has spread beyond the prostate and are less likely to be cured or have long survival. PSA levels can be used together with clinical examination results and tumor grade to help decide which tests are needed for further evaluation. After surgery or radiation treatment, rising PSA levels can provide an early sign that the cancer is coming back.

Digital Rectal Exam
(Age/Frequency: 50+/annually)

The doctor or health care provider inserts a gloved finger into the rectum to feel for anything not normal. This simple test, which is not painful, can detect many rectal cancers.

Warning Signs and Symptoms

Most cases or early prostate cancer cause no symptoms and are found by a PSA blood test and or digital rectal exam. Some prostate cancers may be found because of symptoms such as slowing or weakening of the urinary stream or the need to urinate more often. These symptoms are not specific, and can also be caused by benign diseases of the prostate, such as nodular hyperplasia. Symptoms of advanced prostate cancer include hematuria (blood in the urine), impotence (difficulty having an erection), and pain in the pelvis, spine, hips, or ribs. These symptoms may also be present with other diseases