Prostate cancer screening: When, how, and how often?

What is prostate cancer?

Prostate cancer is the most common cancer among men, with the American Cancer Society estimating nearly 299,010 new cases in the US this year. Statistically, one in seven men will develop prostate cancer in their lifetime. This cancer is uncommon before the age of 40 and typically affects men over 65.

The prostate is a small gland located below the bladder and surrounding the urethra. Its main role is to produce a component of semen.

Source: American Cancer Society

Prostate cancer begins in the cells of the prostate, forming a tumor that can invade nearby tissues and, in some cases, spread (metastasize) to other areas of the body. Most prostate cancers are adenocarcinomas, accounting for about 90% of cases. The causes are often genetic, such as family history, but lifestyle factors, including smoking, alcohol, and poor diet, may also contribute.

Prostate cancer screening is generally recommended for all men starting at age 50, or age 45 if there is a family history of the disease.

When and how often should you get screened for prostate cancer?

The benefits of routine prostate cancer screening are still debated. Studies, including the European ERSPC and the American PLCO, have shown mixed results regarding whether regular screening reduces prostate cancer-related deaths. Therefore, health authorities do not recommend routine PSA (prostate-specific antigen) testing for men without symptoms.

However, many general practitioners do offer prostate cancer screening to male patients between 50 and 75 years of age. Detecting prostate cancer early can prevent it from progressing to metastatic cancer, which can be fatal. When diagnosed early, prostate cancer is highly treatable, with a cure rate of about 95%. Because prostate cancer often lacks symptoms in its early stages, the absence of symptoms does not rule out the disease. Urinary symptoms, when they appear, are more often due to benign prostate enlargement than cancer. Prostate cancer is typically asymptomatic until it progresses, underscoring the importance of timely detection.

Biennial screening is recommended starting at age 50, as it can identify all types of prostate cancers, with over 80% being detected while still localized.

What does prostate cancer screening involve?

Prostate cancer screening generally includes two key tests:

Digital Rectal Exam (DRE)

In a DRE, the doctor checks the size, firmness, and texture of the prostate by inserting a gloved finger into the rectum. This procedure is painless and allows for an assessment of any irregularities that may indicate potential issues with the prostate.

PSA Blood Test

The PSA test measures the amount of prostate-specific antigen (PSA), a protein produced by the prostate, in the blood. Normally, PSA levels are low in the blood, but they tend to rise with prostate size and age, even without cancer. PSA levels are ideally below 2.5 ng/mL for men under 50 and under 6.5 ng/mL for men approaching 80.

Some precautions are recommended before undergoing PSA testing. It’s best to avoid the test for several days after sexual activity, a rectal exam, or physical activities like cycling, as these can temporarily raise PSA levels and potentially skew results.

If you are considering prostate cancer screening, consult with your primary care physician. They can guide you on the steps involved and discuss any precautions to ensure accurate results.

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