Prostate Cancer Screening

Side view of male pelvic organs showing digital rectal exam.The prostate is a gland that lies just below the bladder. It is part of the male reproductive system. Problems with the prostate become more common as a man ages. These problems include prostate cancer, a common cancer in men. This cancer can often be cured or controlled, especially if it is found and treated early. A screening test can help find cancer.

Screening tests can often help detect prostate cancer before it causes any symptoms. But not all healthcare providers agree on whether all men should be screened. Screening can lead to problems, such as finding cancer that may not need to be treated. This can lead to stress and side effects from treatment. Most expert groups advise that men talk with their healthcare providers about the pros and cons of screening.

What is prostate cancer?

Cancer is an uncontrolled growth of abnormal cells. These cells form in one area. They can then spread throughout the body. Prostate cancer causes no symptoms in its early stages. If you have urinary symptoms, these are more likely to be because of another health problem.

Risk factors for prostate cancer

The things that can increase a man’s chance of developing prostate cancer are called risk factors. These include:

  • Age. As you grow older, your risk of developing prostate cancer increases.

  • Family history. If your father or brother has had prostate cancer, your risk of developing it is higher.

  • Race. African-American men are more likely than other men to develop prostate cancer. They are also more likely to die of prostate cancer than other men with this disease.

Screening for cancer

Screening for prostate cancer can help check if you have cancer. Screening tests often include a digital rectal exam (DRE) and a prostate specific antigen (PSA) blood test. Talk with your healthcare provider about the pros and cons of regular screening starting at age 50 or earlier if you are at higher risk.

Before your screening test

Tell your healthcare provider about:

  • Any health problems you have

  • Any family members who have had prostate cancer or other related health problems

  • Medicines, herbs and supplements that you take

  • Any problems with urination or symptoms of urinary tract infection

Digital rectal exam (DRE)

Your healthcare provider may perform a DRE. This is done by gently inserting a lubricated gloved finger into the rectum. Because the prostate is next to the rectum, many prostate problems can be found with this exam.

PSA test

PSA is a protein made by prostate tissue. Your PSA level can be measured with a blood test. A PSA level that is high or rising may be caused by prostate cancer. Or it may be caused by another problem that is not cancer. A lower PSA level means that cancer is less likely. Your healthcare provider may also check:

  • Ratio of free PSA to total PSA. Free PSA is PSA that not bound to a certain protein in the blood.

  • PSA velocity. This is how fast the PSA level is rising over time.

  • PSA density. This is the relation of the PSA level to the size of the prostate.

Many factors can affect PSA levels. These include age, an enlarged prostate, or prostate cancer. These affect PSA levels ongoing. Other factors include a prostate infection or recent sex. These affect PSA levels for a short time. Your healthcare provider can explain how these factors may affect the timing of the PSA test and your results.

Other testing

Problems found with DRE may not be tumors. And a high PSA level does not always mean cancer. More tests may need to be done. After looking at the results of your screening tests, your healthcare provider may advise other tests. These may include:

  • Biopsy. This test takes small samples of tissue from the prostate using a thin, hollow needle. An imaging method, such as ultrasound, is used to help guide the needle to the correct place in the prostate. The tissue samples are then tested in a lab for cancer cells.

  • Imaging tests. If cancer is found, imaging tests might be done to help check if it has spread. Bone scans can check whether cancer has spread to bones. CT and MRI scans can find tumors in bones and soft tissues.