Prostate cancer is often difficult to detect. As it progresses, it’s likely to develop symptoms such as pelvic pain or issues with urinating and ejaculation, but in its early stages, it often has no symptoms, according to the Mayo Clinic.
This is why the best way to beat prostate cancer, which is the most common form of cancer affecting men — with nearly 175,000 new cases in 2019 — is to screen for it and catch it early.
The plusses and minuses of screening
When people with the greatest risk for prostate cancer are identified and screened early in the process, many cases of prostate cancer can be discovered and treated successfully. Screening types range from simple blood tests and rectal exams to more in-depth imaging tests or biopsies.
However, while prostate cancer screening can certainly play a role in detecting prostate cancer early, it is not without some controversy. In recent years, according to the Mayo Clinic, some doctors have pointed out that many cases of prostate cancer are slow growing and don’t require treatment. Therefore, it’s possible that screening, diagnosing and treating prostate cancer in certain people may cause unnecessary complications and do more harm than good.
It’s also possible for prostate cancer screening tests to yield false positives and generate unnecessary anxiety for patients. For example, a PSA (prostate specific antigen) blood test will show elevated levels of PSA for a variety of prostate problems, not just cancer, so tests results could lead some men to think they have cancer when they really don’t.
Overall, the best approach to prostate cancer screening is one that you arrive at after careful discussion with your doctor.
5 ways to screen for prostate cancer
Various methods and tests are used to screen for prostate cancer. They include:
1. PSA test
The PSA test is one of the most common tests for diagnosing prostate cancer, the American Cancer Society says. PSA is a protein that's made by cells in the prostate gland and that shows up in both semen and blood.
- What It’s For. While high levels of PSA in the blood are not a guarantee that a man has prostate cancer, it’s an indicator of prostate cancer or other prostate problems. It also indicates other screening tests might be necessary.
- When You Should Get One. The American Cancer Society says screening should begin at age 50 in men who have an average risk. African-American men or men with a father or brother diagnosed with prostate cancer before age 65 should get tested at age 45. Those with more than one first-degree relative with prostate cancer may want to consider beginning screening at age 40.
- What the Results Might Mean. If your PSA level is between 4 and 10 nanograms per milliliter (ng/mL), then you have about a 25 percent chance of having prostate cancer. PSA levels above 10 ng/mL indicate a chance of more than 50 percent. Both situations mean more testing is needed to determine if prostate cancer is present.
2. Digital rectal exam
When the doctor checks for the presence of a prostate cancer tumor manually, that procedure is known as a digital rectal exam (DRE). In this case, "digital" refers to the doctor’s finger. For this test, the finger is gloved, lubricated and then inserted into the patient's rectum to check for abnormalities. The test is a little uncomfortable but usually isn’t painful.
- What It’s For. A DRE can confirm the diagnosis of a tumor if the PSA blood test had indicated a high level of PSA. The DRE can also be used to detect prostate cancer in men who had a low PSA level.
- When You Should Get One. The DRE may or may not be part of a routine screening for prostate cancer, depending on your doctor’s discretion. This means that the first such test may take place at age 40, 45, 50 or later, depending on your risk level.
- What the Results Might Mean. Your doctor is primarily going by feel with the digital rectal exam. Any hard bumps or lumps in the prostate may indicate the presence of cancer, but additional testing will probably be needed.
3. Prostate biopsy
A biopsy is a medical procedure that involves removing a small sample of tissue from the body, often to check it for cancer or another disease. A prostate biopsy is usually done using a needle to collect a sample of prostate tissue, the American Cancer Society says.
- What It’s For. A biopsy is typically used to confirm a diagnosis of prostate cancer if previous tests indicated you might have it.
- When You Should Get One. Most people with a high PSA level or whose digital rectal exam indicated the presence of prostate cancer may need a prostate biopsy.
- What the Results Might Mean. A pathologist will determine whether the biopsy showed cancer cells. The biopsy may also give the doctor an idea of the nature and severity of the cancer.
4. Imaging tests
Advanced medical imaging tests may also help diagnose prostate cancer. Some of the common tests used for prostate cancer screening include ultrasound, MRI, CT or a bone scan.
- What It’s For. An imaging test may be used to determine the presence or severity of an existing case of prostate cancer. It can also be used to determine if the cancer has spread beyond the prostate.
- When You Should Get One. Your doctor may recommend an imaging procedure at different times in the prostate cancer process. It may be used during the initial diagnosis, to help guide the needle during a prostate biopsy or if your doctor suspects that the cancer has grown worse or spread to other parts of the body.
- What the Results Might Mean. Results will vary based on the specific imaging test used as well as the point in the process that you undergo the test.
5. Genetic testing
Blood and saliva tests can help determine whether a man has a genetic risk for developing prostate cancer or having aggressive prostate cancer. These tests look for the presence of genes that may mean you are at higher risk for cancer, including the BRCA1 and BRCA2 genes.
- What It’s For. Genetic testing can help show whether you are more at risk for prostate cancer because you have a family member with the disease. It can also determine how aggressive a case of prostate cancer might be.
- When You Should Get One. Your doctor may recommend genetic testing for prostate cancer if you already have prostate cancer or you have close relatives who have developed prostate, ovarian or breast cancer.
- What the Results Might Mean. The results of genetic testing can determine the likelihood that you will develop prostate cancer, and they can also help guide your doctor in the treatment of prostate cancer.
How testing affects your treatment and outcome
With testing, doctors can get a sense of the nature and severity of prostate cancer and determine the course of treatment. The prognosis for men with prostate cancer is usually good, and it’s better when the cancer is treated early. About 99 percent of men will survive at least five years after their diagnosis, and most men will live even longer.
Many forms of prostate cancer grow slowly and may not require treatment at first, the Mayo Clinic notes. Instead, active surveillance of the cancer is recommended. When needed, treatment options for prostate cancer include radiation therapy, chemotherapy, hormone therapy, cryotherapy, biological therapy and surgery.
- Key Statistics for Prostate Cancer, American Cancer Society, 2019, https://www.cancer.org/cancer/prostate-cancer/about/key-statistics.html
- Prostate Cancer, Mayo Clinic, 2019, https://www.mayoclinic.org/diseases-conditions/prostate-cancer/diagnosis-treatment/drc-20353093
- Prostate Cancer Screening: Should you get a PSA test?, Mayo Clinic, 2019, https://www.mayoclinic.org/tests-procedures/psa-test/in-depth/prostate-cancer/art-20048087
- Screening Tests for Prostate Cancer, American Cancer Society, 2019, https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/tests.html
- American Cancer Society Recommendations for Prostate Cancer Early Detection, American Cancer Society, 2019, https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/acs-recommendations.html
- Tests to Diagnose and Stage Prostate Cancer, American Cancer Society, 2019, https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html
- Genetic Testing for Prostate Cancer: What You Should Know, Urology Care Foundation, 2019, https://www.urologyhealth.org/patient-magazine/magazine-archives/2018/fall-2018/genetic-testing-for-prostate-cancer-what-you-should-know
- What Is Prostate Cancer?, Urology Care Foundation, 2018, https://www.urologyhealth.org/urologic-conditions/prostate-cancer