When people hear the words "prostate cancer screening," they immediately picture an uncomfortable physical examination. That perception alone can cause some men to delay talking with their healthcare provider. The reality is that prostate cancer screening can be much more straightforward than many people expect. Dr. Kushal Naha, Medical Director, Genitourinary Oncology, Parkview Packnett Family Cancer Institute, explains what men should know about this procedure.
What is a common misconception about prostate cancer screening?
Most people associate prostate cancer screening primarily with a digital rectal exam (DRE). During a DRE, a healthcare professional inserts a gloved, lubricated finger into the rectum to feel the prostate for abnormalities. While a DRE can be part of a prostate evaluation, screening does not necessarily begin with a physical exam. In fact, screening should begin with a discussion between the patient and their provider about individual risk, potential benefits and possible downsides to screening. An important component of this process is the prostate-specific antigen (PSA) blood test.
This distinction is important because fear or embarrassment about a physical examination should not prevent someone from having a conversation about prostate health.
What does a typical prostate cancer screening look like?
For someone who has never been screened, the process generally starts with a conversation with a healthcare provider. They'll typically obtain relevant patient information, including age, a family history of prostate cancer, known medical conditions and life expectancy, previous PSA results and urinary symptoms.
If screening is appropriate and the patient chooses to proceed, the PSA blood test is commonly the next step. Depending on the individual circumstances, the medical provider may also perform or recommend a DRE.
An elevated PSA level does not automatically mean that cancer is present. The health care provider may repeat the PSA test, consider other tests or imaging, or refer the patient to a urologist for further evaluation.
What is the PSA blood test and what does it say about prostate health?
PSA stands for prostate-specific antigen. It is a protein that is produced by both normal and cancerous prostate cells. The PSA test measures the amount of this protein in a person's blood.
While the PSA can provide useful information about prostate health, it is not a cancer test that gives a simple yes-or-no answer.
PSA can be elevated for several reasons, including:
- Benign prostatic hyperplasia (BPH), a noncancerous enlargement of the prostate
- Prostate inflammation or infection
- Recent procedures involving manipulation of the prostate gland
- Prostate cancer
- Age
There is no single PSA number that can definitively distinguish cancer from a noncancerous condition.
If a PSA result is higher than expected, the next step may be to repeat the test to confirm the finding. Depending on the results and the patient's circumstances, their healthcare provider may monitor PSA levels over time, order additional blood or urine tests, perform a DRE or request imaging such as an MRI.
These tests may ultimately lead to a recommendation of prostate biopsy, a procedure that directly assesses whether cancer cells are actually present in prostate tissue.
What would you say to someone putting off screening because they are uncomfortable with a prostate exam?
That feeling is understandable. Many men are uncomfortable discussing or even imagining a prostate examination. However, embarrassment should not stand in the way of having a conversation about health.
Discussing concerns and fears about testing with a trusted health care provider is not a commitment to undergoing testing. The goal is to understand any risks involved, discuss the potential benefits and limitations of such testing, and then make an informed choice. Screening is ultimately a personal decision that every person should make for themselves.
At what age should men start talking with their healthcare provider about screening?
There is no universally accepted age at which every man should begin screening. The American Cancer Society (ACS) recommends a discussion about prostate cancer screening at:
- Age 50 for men at average risk who are expected to live at least another 10 years
- Age 45 for men at high risk, including African American men and men with a first-degree relative diagnosed with prostate cancer before age 65
- Age 40 for men at even higher risk, including those with more than one first-degree relative diagnosed with prostate cancer at an early age
On the other hand, the U.S. Preventive Services Task Force (USPSTF) recommends that men aged 55 to 69 decide about PSA-based screening after discussing potential benefits and harms with a clinician, and recommends against routine PSA-based screening for men aged 70 and older.
That said, no single screening schedule applies to every man. The frequency of PSA testing can depend on several factors including previous PSA readings, age, family history, general health and personal choice. This is another reason why screening is better viewed as an ongoing conversation rather than a one-time event.
Can prostate cancer develop without noticeable symptoms?
Early prostate cancer often does not cause noticeable symptoms, and prostate cancers can often be diagnosed by screening well before the onset of problems.
Urinary symptoms can occur with prostate problems, but they do not necessarily mean cancer. In fact, such symptoms are often related to benign enlargement of the prostate and cannot be relied upon to detect prostate cancer. Symptoms that might deserve medical attention include:
- Pain or difficulty with urination
- Changes in urinary frequency or flow
- Visible blood in the urine or semen
- Pelvic or back pain
These symptoms can have many possible causes and do not automatically mean prostate cancer, but they should be discussed with a healthcare professional.
What is one thing more men should understand about prostate cancer screening?
If you're approaching the age when screening becomes relevant, or have a family history of prostate cancer, you should not let discomfort or uncertainty stop you from asking questions.
Speaking with your primary care provider to help determine personal risk is the first step toward making an informed decision about whether prostate cancer screening is right for you.
If you need help scheduling an appointment or establishing care with a provider, our Access Center can help. Call anytime at 877-PPG-TODAY or 877-774-8632 for assistance.
