Prostate Cancer Screening: 5 Things Every Guy Needs to KnowSep. 16, 2022 - Katie McCallum
You probably already have a long list of things to get done, and we don't take lightly adding on to it. But it's time to talk about why — and when — prostate cancer screening may need to be a priority on your to-do list.
Prostate cancer is the most commonly diagnosed cancer in men, with the National Cancer Institute estimating that 268,490 new cases will be diagnosed in 2022. It's also the No. 2 cause of cancer death in men, projected to take almost 35,000 lives by year's end.
"About 1 in 7 men will develop prostate cancer in their lifetime," says Dr. Brian Miles, a urologist with expertise in prostate cancer surgery at Houston Methodist. "Of those, another 1 in 7 will die of it."
Screening for prostate cancer doesn't help prevent the disease. But if cancer has developed, it can help improve treatment outcomes.
Why is prostate cancer screening important?
"The mortality rate of prostate cancer becomes much higher when it's found late," warns Dr. Miles. "Caught in the early stages, however, it's a disease that's easily treated, easily controlled — though this does mean we need to find it before it's progressed."
And that's where prostate cancer screening comes in, a way of detecting prostate cancer early — before symptoms begin, when it's most treatable. It helps reduce the chance of the cancer spreading or requiring aggressive treatment.
What is prostate cancer screening?
"The most well-known screening test for prostate cancer is called the PSA test," says Dr. Miles. "PSA stands for prostate specific antigen. It's a protein produced by the prostate gland."
Since this protein is made by even healthy prostate tissue, detecting small amounts in the blood isn't concerning. It's normal, in fact. High PSA levels, however, is a sign something may be wrong in your prostate. Checking PSA levels is as simple as running a blood test.
"Elevated PSA doesn't definitely mean a man has prostate cancer, but it can help determine who we need to screen further," explains Dr. Miles.
A biopsy of prostate tissue is the ultimate prostate cancer screening tool — it's also how it's officially diagnosed — but Dr. Miles adds that a few more tests can be used prior to that. These include a digital rectal exam and, in some cases, a new, more sensitive blood test.
"Not every man is going to need screening beyond the PSA test, but these other screening tools we have can help further refine a person's prostate cancer risk and determine whether biopsy is truly needed to rule out or confirm a diagnosis," says Dr. Miles.
And if your doctor does recommend biopsy, Dr. Miles says that it's not as bad as you might think.
"Biopsy of prostate is not a big deal," adds Dr. Miles. "There's really no pain and it's safe to do, although it's uncomfortable due to the ultrasound probe."
When does prostate cancer screening start?
Any man can develop prostate cancer, but some are higher risk.
Prostate cancer is most common in older men, with the average age at diagnosis being 67. For this reason, most men don't need to start being screened for it until they're over the age 50, Dr. Miles says.
"There are two factors that warrant screening earlier than this," adds Dr. Miles. "If you're African American or if you have a family history of prostate cancer, you're considered higher risk and we recommend you start getting PSA tests done around age 40."
Where do you get prostate cancer screening?
Once it's appropriate for your age, prostate cancer screening starts as part of your routine check-up with your primary care doctor.
"If you're over age 50 — or younger but have a higher risk for prostate cancer — ask your doctor about PSA testing," recommends Dr. Miles.
Since PSA levels are checked through the blood, your doctor can simply add it to your routine blood test panel. If your PSA levels are normal, the only action needed is to have them rechecked periodically. Your doctor can help you understand how frequently you need to undergo screening at that point.
What happens if your PSA levels are high?
"If your PSA is elevated, your doctor will refer you to a urologist for follow-up screening," says Dr. Miles. "Follow-up includes a digital rectal exam, where we feel the prostate for any abnormality."
Healthy prostate tissue is firm, but still somewhat soft — like the skin at the bottom corner of your palm. Prostate tissue that feels harder — as hard as, say, your knuckle when it's bent — is considered suspicious and always followed up with a biopsy.
Even if your digital rectal exam is normal, some urologists may use a more sensitive blood test to check the levels of a few other proteins within the same family as PSA. This additional test can help safely delay or avoid the need for biopsy.
"If this blood test is also abnormal, it suggests the person is at higher risk and will need to biopsy," explains Dr. Miles. "If the result is normal, it suggests they are at lower risk and we can simply monitor their PSA levels each year moving forward."
If biopsy confirms prostate cancer, the next steps can range from monitoring the cancer to treating it — depending on the severity.
"A low-grade, non-aggressive prostate cancer can sometimes simply be watched for quite some time — called active surveillance — before requiring treatment," says Dr. Miles. "If the cancer is aggressive or has progressed to a later stage, your doctor will discuss treatment options with you."