Prostate cancer is the second leading cause of cancer-related deaths among men in the United States each year. But many men are unsure whether or when they should be screened for the disease.
Doctors at The University of Texas MD Anderson Cancer Center suggest that men at risk of prostate cancer talk to their health care providers to discuss whether screening is appropriate and which tests should be used.
The goal of screening is to detect prostate cancer early—before it causes symptoms or spreads to other parts of the body. Symptoms of prostate cancer include lower back pain, problems with urination, and erectile dysfunction. However, these symptoms may not appear before the cancer is advanced.
Who should be screened for prostate cancer and at what age depends on the individual’s risk factors for prostate cancer. Each individual should discuss the general recommendations below with his own doctor when choosing whether to be screened.
Men are at increased risk of prostate cancer if they are African American or have a family history of prostate cancer. Men 40 years or older at increased risk for prostate cancer should meet with their primary care physicians to discuss whether screening is a good idea. MD Anderson recommends screening for prostate cancer every year starting at age 45 years for men at increased risk.
Men without a family history of prostate cancer who are not African American are at average risk of the disease. For such men, MD Anderson recommends annual prostate cancer screening between the ages of 50 and 75 years. Men 76–84 years old should talk to their physicians about screening. MD Anderson recommends that men 85 years or older not be screened.
Two tests are typically used to screen for prostate cancer. One is the prostate-specific antigen (PSA) test. This simple blood test measures the amount of PSA (a protein produced in the prostate) in the blood. High amounts of PSA indicate a high risk of prostate cancer. Furthermore, an increase in PSA over time can be a warning sign. MD Anderson recommends that an individual track changes in his PSA over time to determine whether further diagnostic tests are needed. It is important to note that a high PSA number does not always indicate prostate cancer; it can also mean an enlarged prostate or other prostate problems. On the other hand, a low PSA number does not rule out the possibility of prostate cancer.
The other test, usually used in conjunction with the PSA test, is the digital rectal exam. In a digital rectal exam, a physician checks through the lower rectum for abnormal prostate findings such as lumps. The PSA test and digital rectal exam together provide more accurate screening than either test used alone.
If the PSA test and digital rectal exam reveal something abnormal, tests such as transrectal ultrasonography, transrectal magnetic resonance imaging (MRI), and transrectal biopsy can determine whether or not the abnormality is prostate cancer.
During a transrectal ultrasound examination, a probe is inserted into the rectum, and sound waves produce a picture of the prostate.
Transrectal MRI produces a more detailed picture of the prostate and the area around it than does ultrasonography, but MRI is more expensive. The MRI procedure also involves inserting a probe into the rectum.
When MRI or ultrasonography shows an abnormal area on the prostate, a transrectal needle biopsy is done to remove a small sample of tissue from that area. The biopsy is often done with guidance from transrectal ultrasonography. The tissue is viewed under a microscope to see if the cells are cancerous.
If the tests indicate that a man has prostate cancer, he should talk with his doctor to determine whether treatment or watchful waiting is the best course of action. Not all patients with prostate cancer require immediate treatment, and those who do may have several options.
– K. Nair
For more information, ask your physician, read MD Anderson’s prostate cancer screening guidelines or call askMDAnderson at 877-632-6789.
OncoLog, August 2015, Volume 60, Issue 8