There are currently two common tests available in preventive medicine to screen for early detection of prostate cancer – the prostate specific antigen (PSA) and the digital rectal examination (DRE) tests. The PSA blood test is sometimes combined with the DRE where the doctor feels your prostate with a finger to detect any surface anomalies. This information is designed to help men understand the importance of early detection and to decide if they want to be screened for prostate cancer.
The information presented here is to help men who do not have prostate symptoms decide if they want to be tested. If you are having prostate symptoms now, such as pain when you pass your urine, blood in your urine, or trouble passing urine, see your doctor now. These are often symptoms of other non-cancer prostate problems, but they can also be caused by prostate cancer, so you should speak with a doctor about them as soon as possible.
When you get a PSA test you should keep track of your level. This would be an excellent time to talk with your physician about the meaning of the test results. For future tests you should also be aware of any increases in your PSA level and discuss those with a doctor. The earlier prostate cancer is detected the better your chances of treatment and survival.
CPCC recommends that certain men have annual prostate examinations. These are men, who are considered at-risk for prostate cancer. Specifically, CPCC recommends that men in the following risk categories be screened annually for prostate cancer:
All men age 40 and above
At age 35 for African American men, or men with a family history of prostate cancer
If you have a personal physician, make sure that screening tests are conducted annually. Many community organizations also hold annual prostate cancer screening events, which provide opportunities to be tested free of cost.
In recent years there has been a decrease in deaths from prostate cancer, and early diagnosis and treatment is a reason for at least part of that drop in mortality. Benefits of early detection include the possibility that the PSA test may indicate cancer, which, in consultation with a doctor, can be confirmed or not confirmed through a biopsy test. If confirmed and found early before it has spread, your doctor will have a better chance to prescribe a treatment leading to cure and long-term survival. In any case, testing can give you peace of mind. CPCC recommends that prior to having a biopsy to confirm diagnosis of prostate cancer indicated by a PSA/DRE test a doctor should be consulted for a fully informed decision.
A PSA test will measure the level of prostate specific antigen, a protein made by the prostate gland, in your blood. The level indicated may allow your doctor to know if you need to have a biopsy for final diagnosis. A biopsy is done with a needle that removes tiny pieces of the prostate gland for analysis and is performed on an outpatient basis. If the PSA level is 4 or higher, a biopsy may be recommended. PSA level of 4 or higher will find prostate cancer in about 30 of every 100 men. Generally, for PSA levels below 4 (or 2.5 in younger men), the doctor will recommend continuous annual monitoring. A biopsy still may be recommended by your doctor, if a PSA is below 4, under certain circumstances, such as, an alarming rate of change in the PSA level or assessment of men in certain risk categories.
Biopsies for PSAs below 4 will find prostate cancer in 15 out of 100 men. Diagnosing prostate cancer requires a biopsy so that the tissue can be examined under a microscope. The PSA/DRE test is only the first level of screening to allow a physician to discuss your options and risks in having a biopsy. It is important to establish your PSA baseline and to monitor subsequent levels against the previous level. Often the rate of change can be more important than a single reading.
Knowledge is power: By careful use of the PSA and other tests, you as an objectively informed man, may be able to have knowledge of your PSA and of your risk for clinically significant disease without the downside of automatically undergoing treatment that in some cases may not be necessary.