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Prostate Cancer Screening

The prostate is a gland that lies just below the bladder. It wraps around the urethra, which is the tube that carries urine and semen out of penis. The prostate 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's found and treated early (when it's still small and only in the prostate). Screening tests are used to help find cancer early in people who have no symptoms of cancer. Prostate cancer causes no symptoms in its early stages.

Screening tests can often help find prostate cancer before it causes any symptoms. But not all healthcare providers agree that all men should be screened. This is because screening can lead to problems, like finding cancer that may not need to be treated. This can lead to stress. It can also lead to major side effects from treatment may not have been needed. Most experts agree that men should talk with their healthcare providers about the pros and cons of screening before it's done.

What is prostate cancer?

Prostate cancer is an uncontrolled growth of changed (mutated) prostate cells. These cells don't look, act, or work the way they should. Prostate cancer starts in the prostate. But over time, it can grow and spread throughout the body.

Risk factors for prostate cancer

Things that can increase a man’s chance of 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 is higher.

  • Race. African-American men are more likely than other men to develop prostate cancer. They're also more likely to die of prostate cancer than other men with this disease. The reasons for this are not clear.

Screening for cancer

Screening for prostate cancer can help check if you have cancer before it causes problems. 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, vitamins, 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 putting a lubricated gloved finger into your rectum to feel the surface of your prostate (which is right next to your rectum). Many prostate problems can be found with this exam.

Side view of male pelvic organs showing digital rectal exam.
The DRE takes just a few seconds.

PSA test

PSA is a protein made by prostate cells. Your PSA level can be measured with a blood test. A PSA level that's high or has been going up over time may be caused by prostate cancer. But it might also be caused by another problem that's not cancer. A lower PSA level means that cancer is less likely. Your healthcare provider may also check:

  • Percent-free PSA (fPSA). This is the ratio of free PSA to total PSA. Free PSA is PSA that's not bound to a certain protein in the blood.

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

  • PSA density (PSAD).  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. Other factors can cause short-term PSA changes, like a prostate infection, certain medicines, or recent sex. Your healthcare provider can explain how these factors may affect the timing of the PSA test and your results.

Other testing

Here's the problem with prostate cancer screening: 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 pieces of tissue (samples) from the prostate using a thin, hollow needle. An imaging test, like ultrasound or MRI, is used to help guide the needle to the right 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 see 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.

Online Medical Reviewer: Kimberly Stump-Sutliff RN MSN AOCNS
Online Medical Reviewer: Lu Cunningham RN BSN
Online Medical Reviewer: Richard LoCicero MD
Date Last Reviewed: 12/1/2019
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