Prostate Cancer Screening
Prostate cancer is one of the most common types of cancer in men, affecting more than 3 million males in the US annually. It is a cancer that affects the walnut sized gland located under the bladder and in front of the rectum. Once a malignant cells develop, those cells multiply much more quickly than normal cells. Prostate cancer can metastasize into the body, including into the bones, and become life-threatening. Prostate cancer screening and early detection is important so cancer can be treated in its earliest and most treatable stages.
The Prostate Cancer Screening Procedure
There are two components of prostate cancer screening: a digital rectal examination to feel the prostate (DRE) and a prostate-specific antigen (PSA) blood test. MRI technology may help to evaluate abnormalities in the prostate.
Digital Rectal Examination
The digital rectal examination is normally performed as part of a comprehensive physical examination during which the provider inserts a gloved finger in the rectum to feel for any malformations, abnormal texture or growths on the prostate gland.
Prostate-Specific Antigen or PSA Blood Test
The PSA lab test determines whether the individual has elevated levels of PSA in his blood. While PSA is a protein produced by normal cells as well as by cancerous ones, malignant cells typically produce higher levels. Although men whose PSA level if over 4.0 nanograms per milliliter are considered higher risk to have prostate cancer, more recent studies show more variability, according to age, medical conditions, and even race and ethnicity. This is one reason that PSA is monitored at least annually to help determine trends.
It is important to note that PSA levels vary among various individuals and can be increased by factors other than a malignancy. These factors include:
● Prostatitis (inflammation of the prostate)
● Benign prostate hyperplasia or BPH (enlarged prostrate)
● Recent ejaculation
● Certain medical procedures, such as a recent prostate biopsy
● Certain medications, especially those prescribed for BPH
● Recent bicycle riding
● Urinary tract infections
● Prostate trauma 2
There is controversy surrounding which men should undergo the PSA screening evaluation. While the Center for Disease Control (CDC) recommends prostate screening only for men who have symptoms, the American Urological Association and the American Cancer Society recommend testing for men at elevated risk for developing prostate cancer, determined by factors such as age and family history of the disease. Organizations and physicians recommending PSA tests typically recommend them for patients between the ages of 40 and 75 or for those with a family member who has had the disease. It is important to have the conversation with your provider to determine if PSA screening is right for you.
Pros and Cons of Prostate Cancer Screening
While PSA screening can help to detect prostate cancer at earlier stages, some prostate cancers are very slow-growing and may never spread beyond the gland itself. Those cancers are generally observed with active surveillance. In addition, PSA screening is not an absolute test for prostate cancer. In some circumstances, PSA testing may yield false positive, or false negative results. Because the treatment for prostate cancer can have serious side effects, including loss of erections or incontinence, many men are reluctant to undergo treatment. Treatment should be tailored to each specific case. Not every prostate cancer requires definitive treatment. When prostate cancer is detected at an early stage, it is more likely to require less aggressive treatment with fewer side effects.
For some men, having aa annual PSA screening with negative results provides peace of mind but for others, it leaves nagging doubts. Similarly, for some men, a PSA with positive results provides the resolve that prompt definitive intervention will treat the disease effectively; for others, it creates confusion about which course of action to pursue as there are many effective treatments for prostate cancer.
Generally speaking, good results of a digital rectal exam, coupled with a normal PSA test, provide reassurance that it is unlikely the patient has clinically significant prostate cancer. In the end, an informed decision has to be made by the patient in consultation with his provider