Prostate cancer screenings

Description

Cancer screenings can help find signs of cancer early, before you notice any symptoms. In many cases, finding cancer early makes it easier to treat or cure. However, at present it is not clear if screening for prostate cancer is helpful for most men. For this reason, you should speak with your health care provider before having a prostate cancer screening.

Types of Screenings

Prostate-specific antigen (PSA) test is a blood test that checks the level of PSA in your blood.

  • In some cases, a high level of PSA could mean you have prostate cancer.
  • But other conditions can also cause a high level, such as infection in the prostate or an enlarged prostate. You may need another test to find out if you have cancer.
  • Other blood tests or a prostate biopsy can help diagnose a cancer if the PSA test is high.

Digital rectal exam is an test where your provider inserts a lubricated, gloved finger into your rectum. This allows the provider to check the prostate for lumps or unusual areas. Unfortunately, most cancers cannot be felt with this type of exam, at least in the early stages.

In most cases, these two tests are done together.

Imaging tests such as an ultrasound or an MRI do not do an accurate job of screening for prostate cancer.

Benefits and Risks of Screenings

The benefit of any cancer screening tests is to find cancer early, when it easier to treat. But the value of PSA screening for prostate cancer is debated. No single answer fits all men.

Prostate cancer often grows very slowly. PSA levels can begin to rise years before a cancer causes any symptoms or problems. It is also very common as men age. In many cases, the cancer will not cause any problems or shorten a man's life span.

For these reasons, it is not clear if the benefits of routine screenings outweigh the risks or side effects of being treated for prostate cancer once it is found.

There are other factors to think about before having a PSA test:

  • Anxiety. Elevated PSA levels do not always mean you have cancer. These results and the need for further testing can cause a lot of fear and anxiety, even if you do not have prostate cancer.
  • Side effects from further testing. If your PSA test is higher than normal, you may need to have a one or more biopsies's to find out for sure. A biopsy is safe but can cause problems such as an infection, pain, fever, or blood in the semen or urine.
  • Overtreatment. Many prostate cancers will not affect your normal life span. But since it is impossible to know for sure, most people want to get treatment. Cancer treatment can have serious side effects, including problems with erections and urinating. These side effects can cause more problems than the untreated cancer.

Who Needs Screenings

Experts do not agree about which men should have prostate screenings and when. All of them recommend discussing with your doctor both the reasons to have and not to have a PSA test.

  • The United States Preventive Services Task Force recommends against PSA-based screening for prostate cancer for all men.
  • The American Cancer Society recommends that starting at age 50, men should talk with their providers about the pros and cons of prostate cancer screening. Men with a family history of prostate cancer and African-American men should have this talk at age 40 to 45. When and how often a man should be retested depends on his PSA level.
  • The American Urological Association recommends the test for men ages 55 to 69, after discussing risks and benefits. They recommend retesting every 2 years.

Talk with your provider about your health history and risk factors. Together you can decide whether prostate cancer screening is right for you.

References

American Urological Association. Early Detection of Prostate Cancer: AUA Guideline. April 2013. Available at: www.auanet.org/education/guidelines/prostate-cancer-detection.cfm. Accessed August 28, 2015.

Chou R, Croswell JM, Dana T, Bougatsos C, Blazina I, et al. Screening for prostate cancer: a review of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155(11):762-71.

National Cancer Institute. Prostate Cancer Screening -- for health professionals. Revised April 2, 2015. Available at: www.cancer.gov/types/prostate/hp/prostate-screening-pdq#section/all. Accessed August 28, 2015.

Smith RA, Manassaram-Baptiste D, Brooks D, et al. Cancer screening in the United States, 2014: a review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin. 2014 Jan-Feb;64(1):30-51.

U.S. Preventive Services Task Force. Prostate Cancer: Screening. May 2012. Available at: www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/prostate-cancer-screening. Accessed August 28, 2015.

Review date:
December 07, 2016
Reviewed by:
Christine Zhang, MD, medical oncologist, Fresno, CA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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