Screening Tests for Prostate

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Prostate cancer is the second leading cause of death in men after lung cancer, and the most common cancer in men. Fortunately, since most prostate cancer is slow growing, only 30 percent of men diagnosed with prostate cancer will die from it. So far, research has not confirmed that early detection of prostate cancer leads to treatment that will prolong life. Testing is needed to screen for prostate cancer to improve treatment.

There are two methods used to screen for prostate cancer in men. First there is a blood test used to measure PSA (prostate specific antigen), a protein produced by the prostate gland. PSA levels tend to rise when prostate cancer is present. Unfortunately, the test has both high false positives and high false negatives making results questionable. The test also cannot distinguish if the prostate cancer is slow growing and unlikely to cause symptoms, or a highly aggressive form. The other important screening test is the digital rectal exam (DRE), where a doctor inserts a gloved finger into the rectum to feel for lumps or irregularity of the prostate. The DRE has an 85 percent false positive rate, where abnormalities felt but cancer is not present. If either the PSA or DRE is abnormal, further evaluation is warranted. A prostate biopsy may need to be performed, using a needle, which is inserted into the prostate through the rectum. Biopsy is the only truly effective test that can prove if cancer cells are present.

Prostate cancer can be treated by a variety of means. The treatment decision must be based on the appearance and spread of the cancer, general health condition, one’s symptoms, and how each individual weighs the potential risks of the different therapies offered. No therapy has yet proven to extend life, although some treatments may reduce symptoms making life much more bearable. Options include watchful waiting, radiation therapy, prostatectomy, and hormone therapy. Each option has potential and serious side effects.

PSA screening should be optional for men at average risk of contracting prostate cancer. Advice varies for when PSA are beneficial, and when PSA screening are recommended. The American Cancer Society and American Urological Association both recommend offering PSA screening to men ages 50 to 70 at average risk, with appropriate counseling. African American men and men with family members who have developed prostate cancer before age 70 are at much higher risk. These men should discuss prostate-cancer screening with their doctors.