Cancer screening is the best way to find cancer early. An early diagnosis means easier, more effective treatment and less chance of it spreading. Many cancers, including prostate cancer, have no symptoms in the early stages. If you don’t have symptoms or regular screenings, prostate cancer can grow without you knowing you have it. Age is one of the factors associated with your risk, so identifying when you should get a screening can depend on many different factors. While men that don’t have existing high risk factors may be able to wait longer than other men to receive screening, it is important to evaluate each case individually.
What is Prostate Cancer Risk?
Some men have a higher likelihood of developing prostate cancer. Risk increases with:
- Age – It’s more common after age 50.
- Race – Black men have the highest risk of prostate cancer compared to other races and are more likely to have a quick-growing, aggressive type.
- Family history - A blood relative who has or had prostate cancer. A family member with breast cancer can also increase your prostate cancer risk. Further testing can be done to determine if there is genetic link.
- Obesity – Being overweight increases your risk and the risk of having the aggressive type.
- Nutrition and Diet- An unbalanced diet high in animal fat and red meat, and low in vegetables and fruits.
When to Start Prostate Cancer Screening
The American Cancer Society recommends that men at average risk “consider” screening beginning at age 50. High-risk men should consider it at age 45 or even age 40 if they are very high risk. After age 70, most men of average health can stop prostate cancer screenings.
Experts recommend that men should carefully evaluate their history and risk factors for prostate cancer when deciding to get screened for cancer. They should have all the information about risks, benefits, and treatment complications.
During the discussion, your doctor will advise you about screening details and possible treatments. The advice will be based on your age, general health, and preferences. Men who don’t have prostate cancer symptoms and whose life expectancy is less than ten years do not need screening. It will not provide any benefit during their remaining lifespan.
Benefits of Prostate Cancer Screening
Screening can find cancer early. Early prostate cancer screening increases the chances of a successful cure, decreases the risk of it spreading, and reduces prostate cancer deaths. One death will be prevented for every 1,000 men between 55 and 69 years old who are screened. Additionally, early detection can also help reduce the potential for cancer to spread to other parts of the body.
Are there Cons of Prostate Cancer Screening?
In general, the pros outweigh the cons of cancer screening. However, it’s good to understand there is some possibility the screening will result in further testing that shows cancer is not present. For most men, it’s better to run those extra tests, even if they require a biopsy, than not know whether cancer is present.
Types of Prostate Cancer Screening
There are two standard types of prostate cancer screening tests:
- Prostate-Specific Antigen (PSA) test - a blood test that measures the level of PSA in the blood. PSA is a protein made by the prostate. The higher your level of PSA, the more likely you are to have prostate cancer. However, your PSA level can be higher because of several other conditions that affect the prostate. Therefore, it’s not a completely reliable test. The PSA test may also be used after treatment to check on how well the treatment worked.
Factors that can affect your PSA levels include:
- Age – PSA levels increase as you age, even if you don’t have prostate cancer
- Race
- Taking certain medications
- Having specific medical procedures
- Prostate infection or inflammation
- Enlarged prostate
- Some men’s prostate glands make more PSA than others
In addition to your PSA results, your doctor will also evaluate the size of your prostate, how quickly your PSA levels are changing, and if you’re taking certain medications that affect PSA levels. If the test results are not in the normal range, your doctor may do a biopsy to make a more accurate diagnosis.
- Digital Rectal Exam (DRE) - sometimes used in combination with a PSA test to feel for abnormalities in the prostate. Your doctor inserts a gloved, lubricated finger into the rectum to feel the prostate. However, this method is not reliable for detecting prostate cancer and is not a recommended screening tool.
Next Steps Based on Your Prostate Cancer Screening Results
If your prostate cancer screen was negative, you may only need rescreening every two years, provided your PSA was less than 2.5 ng/mL.
Your doctor will probably recommend an annual screening if your PSA level is higher than 2.5 ng/mL.
PSA levels that are between 4 and 10 are generally considered elevated. This does not mean that there is prostate cancer present, but it is important to evaluate each patient’s condition thoroughly. This can often mean that your doctor will consider more tests. Traditionally this meant moving to a prostate biopsy. A biopsy involves inserting a thin, spring-loaded needle into your prostate to remove samples of prostate tissue from various locations in the prostate. This tissue is then analyzed by pathologists to see whether any cancer cells are present.
Before going directly to a biopsy, doctors now have some other tests they can run to help them decide if a prostate biopsy is the best next step.
- PHI - This blood test called the Prostate Health Index is approved by the FDA for men with PSA scores between 4 and 10. It measures your risk of having prostate cancer. Because an elevated PSA score can mean several different things, this test will help the doctor decide if a prostate biopsy is the next best step.
- Urine test - Detecting a gene called PCA3 in your urine can help your doctor better assess your prostate cancer risk. This gene, specific to the prostate, is often overexpressed (too much of it is present) in the urine if prostate cancer is present. Data shows that about 80% of the time the PCA3 test is positive, prostate cancer is present.
If you’ve been diagnosed with prostate cancer, treatment may not be needed right away. Contact one of our cancer centers in the Portland and Vancouver areas to request a consultation with one of our prostate cancer specialists, who can help you determine the right timing and treatments that may be needed.
Originally posted on July 16, 2017. Revised on September 27, 2021.
