Prostate Cancer Screening

Prostate cancer screening is a process used to detect prostate cancer in men who do not have symptoms of the disease. The goal of screening is to find cancer at an early stage, when it is more treatable.

Methods of Prostate Cancer Screening

• Digital Rectal Examination (DRE): A healthcare provider inserts a gloved finger into the rectum to feel the prostate gland for any abnormalities, such as lumps or hardness.
• Prostate-Specific Antigen (PSA) Test: A blood test that measures the level of PSA, a protein produced by the prostate gland. Elevated levels of PSA may indicate prostate cancer, but can also be caused by other conditions, such as prostatitis or benign prostatic hyperplasia (BPH).
• PSA Velocity Test: A test that measures the rate of change in PSA levels over time. This test can help determine if a man's PSA level is increasing rapidly, which may indicate prostate cancer.
• Free PSA Test: A test that measures the level of free PSA (PSA that is not bound to other proteins) in the blood. This test can help distinguish between prostate cancer and BPH.
• PCA3 Test: A urine test that measures the level of PCA3, a genetic material that is often elevated in men with prostate cancer.

Risk Factors for Prostate Cancer

The following factors increase a man's risk of developing prostate cancer:

• Age: Prostate cancer is more common in men over the age of 50.
• Family history: Men with a family history of prostate cancer are at increased risk.
• Race: African American men are at higher risk of developing prostate cancer than Caucasian or Asian men.
• Genetic mutations: Certain genetic mutations, such as BRCA2, can increase the risk of prostate cancer.

Screening Guidelines

The following organizations have established guidelines for prostate cancer screening:

• American Cancer Society (ACS): Recommends that men at average risk of prostate cancer should start discussing screening with their healthcare provider at age 50. Men at higher risk should start discussions at age 40 or 45.
• American Urological Association (AUA): Recommends that men between the ages of 55 and 69 should undergo routine prostate cancer screening. Men under 40 or over 70 should not be screened unless they have a high risk of developing prostate cancer.
• U.S. Preventive Services Task Force (USPSTF): Recommends that men between the ages of 55 and 69 should discuss the benefits and harms of screening with their healthcare provider and make an informed decision about whether to undergo screening.

Benefits and Harms of Prostate Cancer Screening

The benefits of prostate cancer screening include:

• Detection of prostate cancer at an early stage, when it is more treatable.
• Potential reduction in the risk of death from prostate cancer.

The harms of prostate cancer screening include:

• False-positive results, which can lead to unnecessary biopsies and treatments.
• Overdiagnosis and overtreatment of slow-growing tumors that may not have caused symptoms or death.
• Potential side effects of treatment, such as incontinence and impotence.

What Happens After a Positive Screening Test

If a man's screening test results are abnormal, his healthcare provider may recommend further testing, including:

• Biopsy: A procedure in which a sample of tissue is removed from the prostate gland and examined for cancer cells.
• Imaging tests: Such as ultrasound, MRI, or CT scans to help determine the extent of the cancer.

If prostate cancer is diagnosed, treatment options may include:

• Active surveillance: Monitoring the cancer with regular check-ups and biopsies to see if it grows or spreads.
• Surgery: Removing the prostate gland and surrounding tissue.
• Radiation therapy: Using high-energy rays to kill cancer cells.
• Hormone therapy: Blocking the production of male hormones, such as testosterone, which can fuel the growth of prostate cancer cells.