Prostate cancer screenings
Prostate cancer screening - PSA; Prostate cancer screening - digital rectal exam; Prostate cancer screening - DRE
Cancer screenings can help find cancer at an early stage, 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.
Prostate cancer is the most common cancer in men in the United States. Prostate cancer forms in the prostate gland, and can sometimes be felt on digital rectal examination. This is one of the purposes of the digital rectal exam.
Prostate-specific antigen (PSA) is a glycoprotein in the cytoplasm of prostatic epithelial cells. It can be detected in the blood of all adult men. The PSA level is increased in men with prostate cancer but can also be increased somewhat in other disorders of the prostate.
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 (DRE) is a test in which your provider inserts a lubricated, gloved finger into your rectum. This allows the provider to check the prostate for lumps or unusual areas. Most cancers cannot be felt with this type of exam, at least in the early stages.
In most cases, the first step of prostate cancer screening is the PSA test but not a DRE because the added value of DRE for screening is very small.
Benefits and Risks of Screenings
The benefit of any cancer screening test is to find cancer early, when it is easier to treat. But the value of PSA screening for prostate cancer is debated. No single answer fits all men.
Prostate cancer can grow 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. An elevated PSA levels does 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 level is higher than normal, you may need to have one or more biopsies 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, many 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
Measuring the PSA level can increase the chance of finding prostate cancer when it is very early. But there is debate over the value of the PSA test for detecting prostate cancer. No single answer fits all men.
Before having the PSA test, talk to your provider about the pros and cons. Ask about:
- Whether screening decreases your chance of dying from prostate cancer.
- Whether there is any harm from prostate cancer screening, such as side effects from testing or overtreatment of cancer when discovered.
- Whether you have a higher risk for prostate cancer than others.
If you are under age 55, screening is not generally recommended. You should talk with your provider if you have a higher risk for prostate cancer. Risk factors include:
- Having a family history of prostate cancer (especially a brother or father)
- Having certain genes that can contribute to prostate cancer such as BRCA genes
- Being African American
For men age 55 to 69, PSA testing may be appropriate after discussing it with your provider. For men older than age 70, most recommendations are against screening.
References
National Cancer Institute website. Prostate cancer screening (PDQ) - health professional version.
Nelson WG, Antonarakis ES, Carter HB, DeMarzo AM, DeWeese TL. Prostate cancer. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 81.
US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;319(18):1901-1913. PMID: 29801017
Wei JT, Barocas D, Carlsson S, et al. Early detection of prostate cancer: AUA/SUO guideline part I: Prostate cancer screening. J Urol. 2023;210(1):46-53. PMID: 37096582
Version Info
Last reviewed on: 9/6/2024
Reviewed by: Warren Brenner, MD, Oncologist, Lynn Cancer Institute, Boca Raton, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
