Prostate Cancer Screening and Diagnosis
The value of screening for prostate cancer in healthy men continues to be debated, but Deane Center guidelines align with those of the American Urological Association. Men should discuss their prostate cancer risk profile and screening benefits with their primary care physician or urologist and have a baseline prostate-specific antigen (PSA) test at age 40 if they wish to pursue an early diagnosis. The screening should also include a digital rectal exam (DRE) because the DRE can uncover physical abnormalities of the prostate that may be a sign of cancer. Men at higher risk for prostate cancer are African American and those with a family history of prostate cancer; these men should discuss screening with their primary care physician or urologist at age 40.
There is no PSA level which guarantees the absence of cancer. At the same time, most men with an elevated PSA do not have cancer. The PSA blood test should not be reviewed in a vacuum; rather it should be interpreted in the context of a patient’s age, race, family history, size of the prostate, and percentage of free PSA (PSA unbound to other proteins). This type of comprehensive and personalized assessment is essential before making the decision to undergo a prostate biopsy.
Many of our patients ask why they need a prostate biopsy if their PSA is normal but the DRE is abnormal. A biopsy is the only definitive way of diagnosing prostate cancer. Approximately 20 percent of men diagnosed with prostate cancer in the United States have a normal PSA but on biopsy for an abnormality on their DRE are found to have cancerous cells.
Dr. Simon Hall, Director of the Deane Center, says the U.S. Preventive Services Task Force “got it wrong” about the value of PSA testing.