Prostate Cancer Screening

Annual screening starting at age 50 is recommended for men at average risk. For men with a higher risk of prostate cancer, screening should start at age 45. If more than one risk factor is present, screening may start as early as age 40.

A complete prostate cancer screening consists of a prostate-specific antigen (PSA) blood test and a digital rectal exam (DRE).

What is PSA?

Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in the blood. It is normal for men to have a low level of PSA in their blood; however, a high or quickly-rising PSA level can indicate prostate disease, including prostate cancer. Cancer is not the only cause of elevated PSA levels; infection, recent sexual activity, and benign prostate hyperplasia (BPH) can also affect the PSA level. Primary care physicians evaluate and track a man's PSA level and the rate at which it changes. A "normal" but quickly-rising PSA level may suggest a need for further study.

Digital Rectal Exam

The digital rectal exam, or DRE, is a physical exam that checks for abnormalities or bumps on the surface of the prostate. Prostate cancer may appear as a "nodule" or an unusually firm texture of the gland. Sometimes, prostate cancer is apparent only a upon rectal exam, even if the PSA test is normal. This is no time for men to be squeamish! Getting both a PSA test and DRE is recommended; together, these tests can help doctors detect prostate cancer in men who may not show symptoms of the disease.

More about PSA Screening

PSA testing is not perfect. There are false positives and false negatives. However, the PSA blood test still saves lives. Since the advent of this test, many more cases of prostate cancer have been diagnosed at earlier stages and the death rate from this disease has decreased.

Elevated or rising PSA levels may indicate that something may be wrong with the prostate. Men with a quickly-rising PSA level (velocity) over a short period of time are more likely to have prostate cancer than men without much change in PSA. However, factors other than cancer can also cause your PSA to rise, such as an infection in the prostate, certain drugs, and getting older.

Not all men should get screened for prostate cancer.

Although it is an individualized decision, prostate cancer screening is not right for everyone. If a man has less than a 10 year life expectancy due to age or illness, we do not encourage screening.

What to do if results of PSA test or DRE are positive?

After screening and review of your overall health status with your doctor, prostate cancer can be confirmed with a prostate biopsy. Prostate biopsy is the best test for confirming the diagnosis of prostate cancer.

If prostate cancer is detected in the biopsy, you should evaluate all treatment options with your doctor. The benefits and risks should be evaluated. Some prostate cancers may not need immediate treatment; "watchful waiting" is appropriate when the cancer is slow growing or inactive.

Each man has different priorities when deciding whether to be screened and treated for prostate cancer. Men should talk to their doctor or someone at The Prostate Center for more information, and to determine if they should be screened and/or treated for prostate cancer.