Making a sound decision to be screened for prostate cancer depends on a number of factors. Current screening methods used to detect prostate cancer are not 100 percent accurate. However, prostate cancer screening leads to early detection, when treatment will be most effective. Ultimately, the decision to be screened should be made jointly with your physician. Here are some frequently asked questions about prostate cancer screening.
1. How many men are affected by prostate cancer?
Prostate cancer is the most common non-skin cancer related malignancy found in American men. While prostate cancer is second only to lung cancer as the most common cause of cancer death in men, many men live with prostate cancer rather than die from it. According to the National Cancer Institute, about one in six men in the United States will be diagnosed with prostate cancer in their lifetime, and 3 percent of those men will die from the disease.
2. What increases my risk for getting prostate cancer?
Knowing your personal risk factors can help you decide if and when you want to begin prostate cancer screening. Key risk factors include the following:
3. What is a PSA test, and how reliable is it?
A prostate-specific antigen (PSA) test measures a protein in the blood produced by prostate tissue. Cancer cells usually produce more PSA than regular cells, which may cause the PSA blood level to rise. However, analyzing a PSA score isn't as simple as it sounds. Other conditions can also cause PSA levels to rise, including infection or inflammation of the prostate gland or benign prostatic hyperplasia (BPH). BPH is a non-cancerous enlargement of the prostate that affects many men as they age.
To help account for potentially false readings, other types of analysis can be applied to get more accurate information from the PSA test. Measuring PSA velocity, or how fast a man's PSA rises over time, can be a clearer indicator for more testing — even when the total number is considered low or borderline (a PSA of less than four is low; between four and 10 is borderline). PSA velocity is most effective when PSA levels are measured annually, or at least three times over a period of 18 months or more.
4. Why do I also need a digital rectal exam?
The prostate gland is located just in front of the rectum, which makes it easy for a physician to feel for bumps or hard spots. While a digital rectal exam may not be needed as an initial screening test, it can be useful in determining next steps after a PSA test result. It can also be used if prostate cancer is suspected in cases where PSA is not elevated as a secondary test.
5. What are the pros and cons of having the PSA test?
6. What if the results of prostate cancer screening indicate I need further tests?
You may feel anxious over the possibility of more tests, but most men who go for further testing do not have cancer. If your PSA test or DRE suggests a problem, your doctor may refer you to a urologist. Additional testing will help determine if the problem is cancer or something else.
Possible follow-up tests your doctor may perform include:
7. What is the current recommendation for age and frequency of prostate cancer screening?
While the option of screening should be based on shared decision making between the physician and patient, the general screening recommendation is that all men who have a life expectancy of at least 10 years should be offered the PSA test and DRE annually beginning at age 55. For men at higher than average risk for prostate cancer (African-American men and those with a first-degree relative with the disease), screening may begin as early as age 40.
Remember, no simple test, including the PSA and DRE, can reveal a cancer's type and whether it's aggressive or slow-growing. Men considering screening should be informed of the available evidence and get help when considering their own personal preferences and possible risk factors.
8. Where can I get more information about prostate cancer and prostate cancer screening? The Comprehensive Prostate Cancer Clinic (CPCC) is a group of highly specialized providers within the Cancer Institute at Virginia Mason dedicated to the diagnosis and treatment of prostate cancer. Patients receive high quality care from one of the only completely integrated medical care teams in the state of Washington. Meet the Virginia Mason Care Team and learn more about diagnosing prostate cancer.
In addition, The Centers for Disease Control and Prevention has developed materials for patients about prostate cancer screening.