Prostate Cancer Screening FAQs

Should I Be Screened for Prostate Cancer?

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?
  2. What increases my risk for getting prostate cancer?
  3. What is a PSA test, and how reliable is it?
  4. Why do I also need a digital rectal exam?
  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?
  7. What is the current recommendation for age and frequency of prostate cancer screening?
  8. Where can I get more information about prostate cancer and 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.

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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:

  • Age - Your prostate cancer risk increases with age, rising substantially after age 50. That's why physicians of men approaching age 50 should discuss the potential benefits and limitations of prostate cancer screening before testing begins.
  • Family history - If a first-degree relative (father, brother or son) was diagnosed with prostate cancer at an early age (before 65), you are at higher than average risk for getting the disease. In this case the discussion to screen should begin at age 40. For those men who have had more than one first-degree relative who had prostate cancer, screening should be considered at age 40.
     
  • Ethnic background - African-American men are shown to have a higher risk of developing prostate cancer.
     
  • Diet - While the relationship between diet and prostate cancer is not yet fully understood, rates of the disease are higher in countries where people tend to eat a lot of fat. A diet high in saturated fats (such as animal fats found in red meat) may pose the greatest risk. In addition, a diet high in fruits and vegetables has been linked to a lower risk of cancer.

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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.

  • False-positive — Non-cancerous conditions that raise PSA levels can cause what's known as a false-positive, indicating you might have prostate cancer when you don't.
     
  • False-negative — Some prostate cancers may not produce much PSA, leading to a false-negative result.
     
  • Medication and herbal supplements — Certain medications and herbal supplements have been known to mask a high PSA level.

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.  

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4. Why do I also need a digital rectal exam?
The digital rectal exam (DRE) can sometimes find cancers in men who have had a negative PSA test. It is recommended that both tests be done for complete prostate cancer screening. 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 the DRE is less effective than the PSA test for finding prostate cancer, the two tests combined detect more cancers than the PSA test alone.

5. What are the pros and cons of having the PSA test?

Pros of PSA Screening

  • The PSA test can help diagnose prostate cancer early.
  • Having the test can provide some men with reassurance.
  • Prostate cancer is more likely to respond to treatment and be cured when diagnosed in an early stage.

Cons of PSA Screening

  • Many types of prostate cancer are slow growing and may not cause health problems.
  • A false-negative result, or when the PSA is low but cancer is still present, can lead to a missed diagnosis when treatment is actually needed.
  • There is controversy as to whether PSA screening is linked to decreased deaths from prostate cancer.

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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:

  • Transrectal ultrasound - A video image of the prostate is displayed by way of a small probe inserted in the rectum.
     
  • Biopsy - If cancer is suspected, tiny samples of the prostate can be removed with a special needle. This is usually an office procedure. The samples are examined under a microscope for the presence of cancer cells.

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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 50. 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.

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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.

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