Prostate Cancer Screening
What does “screening” mean?
Screening means looking for signs of disease in
people who have no symptoms. So screening for prostate cancer is looking for
early-stage disease when treatment may be more effective. The main screening
tools for prostate cancer are the digital rectal examination (DRE) and the
prostate–specific antigen (PSA) test. The DRE and PSA test cannot tell if
you have cancer; they can only suggest the need for further tests.
What is the DRE?
The DRE or digital (finger) rectal examination is a quick
exam for checking the health of the prostate. For this test, the doctor
inserts a gloved and lubricated finger into the rectum. This allows the
doctor to feel the back portion of the prostate for size and any irregular
or abnormally firm areas.
What is the PSA test?
PSA stands for "prostate –pecific antigen." PSA is a
substance produced by cells from the prostate gland and released into the
blood. The PSA test measures the PSA level in the blood. A small amount of
blood is drawn from the arm. Photographs of two men's faces The doctor
checks the blood to see if the PSA level is normal. The doctor may also use
this test to check for any increase in your PSA level compared to your last
PSA test.
As a rule, the higher the PSA level in the blood, the more likely a prostate
problem is present. But many factors, such as age and race, can affect PSA
levels. Some prostate glands produce more PSA than others. PSA levels can
also be affected by
* certain medical procedures
* an enlarged prostate
* a prostate infection.
Because many factors can affect PSA levels, your doctor is the best person
to interpret your PSA test results.
How accurate are the screening tests? No test is right all the time and
that is true of the PSA test and DRE. The PSA test is better at suggesting
that small cancers are present, especially those toward the front or sides
of the prostate gland, or deep within it. But the DRE can sometimes help
suggest cancers in men with normal PSA levels. That is why both the PSA test
and the DRE are usually performed.
If 100 men over age 50 take the PSA test
* 85 will have a normal PSA (though a small number of these men will
* have a cancer that was missed by the PSA test). 15 will have a higher
* than normal PSA and require further tests.
After further testing, results will show
* 12 do not have prostate cancer. 3 have prostate cancer.
What do medical experts say about screening? Medical experts agree that
every man needs balanced information on the pros and cons of prostate cancer
screening to help him make an informed decision. Balanced information is
important because medical experts disagree about whether men should be
screened regularly for prostate cancer.
Medical experts who encourage regular screening believe current scientific
evidence shows that finding and treating prostate cancer early, when
treatment might be more effective, may save lives. They recommend that all
men who have a life expectancy of at least 10 years should be offered the
PSA test and DRE annually beginning at age 50. They also recommend offering
screening tests earlier to African-American men, and men who have a father
or brother with prostate cancer.
Medical experts who do not recommend regular screening want convincing
evidence that finding early-stage prostate cancer, and treating it, saves
lives. They believe some of these cancers may never affect a man’s health
and treating them could cause temporary or long-lasting side effects like
impotence (inability to keep an erection) and incontinence (inability to
control the urine flow, resulting in leakage or dribbling). Because they
believe it is unclear if the potential benefits of screening outweigh the
known side effects of treatment, they recommend that all men be given
information on the pros and cons of screening before making their own
screening decision.
When will medical experts know more?
Medical experts are working together
on major research studies to get answers. These studies are called clinical
trials. They will help determine whether a man who gets screened regularly
is less likely to die of prostate cancer than a man who does not get
screened. Clinical trials involve thousands of male volunteers and take a
long time. Results are expected in five to 10 years. They should help
experts know if screening for prostate cancer saves lives.
Should I be screened for prostate cancer?
The decision is up to you and
your doctor. Know your risk factors for prostate cancer and the pros and
cons of screening.
Pros “I will take the screening tests because they will give me peace of
mind. It could mean finding a problem, taking further tests, and treating a
potentially serious prostate cancer. And because there’s no way to tell if
the prostate cancer will cause problems in the future, I want it found early
when treatments might be more effective.”
Cons “I will not take the screening tests until medical experts agree that
finding and treating prostate cancer in its early stages reduce the chance
of dying from it. Screening tests could lead to further tests and treatment
of a prostate cancer that may never cause problems. And treatment can have
serious side effects.”
Prostate Cancer News
Simple Interventions May Increase Prostate Cancer Screening
12 Jul 2007 at 2:00am
Prostate cancer is the most common cancer in American men, with an estimated incidence of 234,460 cases and 27,360 deaths in 2006. Screening for prostate cancer remains controversial due to insufficient evidence to recommend for or against screening. In particular, strategies for encouraging discussion of prostate cancer in high-risk populations have not been tested. [click link for full article]
Practice Patterns In Screening And Management Of Prostate Cancer In Elderly Men
22 Jan 2007 at 8:00am
UroToday.com - Prostate cancer (CaP) screening guidelines are clear about when to initiate screening but only state that it should be discontinued when a man's life expectancy decreases to less than 10 years. [click link for full article]
Is Prostate Specific Antigen Velocity Selective For Clinically Significant Prostate Cancer In Screening?
3 May 2008 at 1:00am
UroToday.com - With the knowledge that screening for prostate cancer will lead to over detection and subsequent over treatment, the call for tests discriminating between non aggressive and aggressive prostate cancer is growing. If pre-biopsy data could make this distinction, a lot of unnecessary biopsies would be spared.
Can Non Malignant Biopsy Features Identify Men At Increased Risk Of Biopsy Detectable Prostate Cancer At Re Screening After Four Years?
21 Nov 2007 at 1:00am
(UroToday.com) - After a non-malignant initial biopsy, a screening participant in the European randomized Study of Screening for Prostate Cancer (ERSPC) will be screened further following the regular screening schedule (re-screen after 4 years). [click link for full article]
Should UK Prostate Cancer Detection Age Be Lowered, In Line With The United States?
17 Nov 2007 at 2:00pm
In many countries prostate cancer screening happens ahead of evidence from ongoing trials. In several countries, early opportunistic screening starts with people aged 50. The Americans have recently adopted a lower age limit after two studies found that raised PSA (prostate specific antigen) levels in males in their 40s was linked to prostate cancer. [click link for full article]
Fewer Prostate Cancer Deaths In The USA Than In The UK May Be Due To Screening
16 Apr 2008 at 5:00pm
An article published in The Lancet Oncologysuggests that a higher incidence of screening for prostate-specificantingens in the USA is associated with a large decrease inprostate-cancer mortality in the USA compared to the UK between 1994and 2004.
Men Should Make Their Own Decision About Prostate Cancer Screening
29 Jan 2008 at 4:00am
The American College of Preventive Medicine (ACPM) has found there is insufficient evidence to recommend for or against routine population prostate screening with digital rectal examination (DRE) or measurement of the serum tumor marker, prostatespecific antigen (PSA).
Behavior, Social Factors Should Be Considered In Addressing Black Men's Prostate Cancer Screening Rates, Study Finds
30 Jun 2008 at 9:00am
"Personal Factors Affecting African-American Men's Prostate Cancer Screening Behavior" (.pdf), Journal of the National Medical Association: The study seeks to identify the personal factors that affect black men's decisions to undergo prostate cancer screenings. Black men have the highest prostate cancer rate of any other racial or ethnic group.
Hair-Growth Drug Artificially Lowers Psa Levels In Prostate Cancer Screening
11 Dec 2006 at 1:00am
The popular hair-growth drug finasteride, taken by millions of balding men, artificially lowers the results of the prostate-specific antigen (PSA) test, the standard screening test for prostate cancer, a multicenter study has found. [click link for full article]
Hair-growth drug artificially lowers PSA levels in prostate cancer screening, study finds
3 Dec 2006 at 10:00pm
The popular hair-growth drug finasteride, taken by millions of balding men, artificially lowers the results of the prostate-specific antigen test, the standard screening test for prostate cancer, a multicenter study has found.
Reactions to 'false-positive' prostate cancer screenings assessed
1 Mar 2007 at 10:00pm
Men who get a "false-positive" prostate cancer result -- an abnormal screening test followed by a biopsy indicating no evidence of cancer -- appear more likely to worry about their subsequent risk of cancer and report more problems with sexual function compared to men with normal screening results.
EPCA-2: A Highly Specific Serum Marker For Prostate Cancer
15 Jul 2007 at 1:00am
UroToday.com- The steady decrease in prostate cancer mortality is indirect evidence that prostate cancer early detection using serum PSA and the digital rectal examination saves lives. Nevertheless, the use of serum PSA for prostate cancer screening remains controversial due to its low specificity. [click link for full article]
"False-Positive" Prostate Cancer Screenings Assessed
5 Mar 2007 at 1:00am
Men who get a "false-positive" prostate cancer result -- an abnormal screening test followed by a biopsy indicating no evidence of cancer -- appear more likely to worry about their subsequent risk of cancer and report more problems with sexual function compared to men with normal screening results, according to a University of Iowa study. [click link for full article]
Characteristics Of Prostate Cancer Detected By Digital Rectal Examination Only
2 Mar 2008 at 2:35am
UroToday.com - A report in the December, 2007 issue of Urology by Dr. Okotie and the group of Dr. William Catalona suggests the digital rectal examination (DRE) remains an important element of prostate cancer (CaP) screening. The group performed the study, as others have suggested that DRE is no longer necessary to CaP screening.
Studying Prostate-Specific Antigen Velocity's Clinical Usefulness
10 Oct 2007 at 3:00am
Some studies have suggested that the rate of change of prostate-specific antigen (PSA) levels may correspond with prostate cancer survival. But this does not necessarily mean that PSA velocity will be valuable as a prostate cancer screening tool, according to a commentary published online October 9 in the Journal of the National Cancer Institute. [click link for full article]