Prostate Cancer Screening

One in nine men living in the U.S. is diagnosed with prostate cancer. In fact, it remains the No. 1 diagnosed cancer and the second leading cause of cancer death among American men. Despite its high incidence, if found early, prostate cancer is one of the most survivable forms of cancer. Early detection is key.

Types of screening tests

The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.

There are two main screening tests for prostate cancer. It’s important to know neither is 100% accurate.

Digital rectal exam (DRE). During a DRE, a physician inserts a gloved, lubricated finger into your rectum to examine your prostate, which is next to the rectum. Your doctor will assess the size of the prostate and feel for any bumps or hard areas on the prostate that may need to be tested for cancer.
Prostate-specific antigen (PSA) test. This is a blood test to check the level of prostate-specific antigen in your blood. A PSA value of 4ng/ml or less if often considered normal. But this is not always the case; lower PSAs may also be associated with prostate cancer. If the initial result is borderline, doctors may recommend repeating the test. For higher PSAs, doctors are likely to recommend additional tests. PSA levels can be affected by:
- Large prostates (Benign Prostate Hyperplasia)
- Infections (prostatitis, urinary tract infections, epididymitis)
- Recent ejaculation
- Trauma
- Recent urinary catheterization
- Recent biking
- Prostate cancer

Who is at risk for prostate cancer?

Male gender and older age: About 6 in 10 cases of prostate cancer are found in men older than 65.

Ethnicity:
- African Americans are 1.6 times more likely to get the disease.
- African Americans are 2.2 times more likely to die of the disease.
Family history:
- Prostate cancer seems to run in some families. Having a father or brother with prostate cancer more than doubles a man’s risk of developing this disease. The risk is much higher for men with several affected relatives, particularly if their relatives were young when the cancer was found.

Additionally, if you have had a relative with any of the following cancers, have had multiple cancers in your family, or are of Ashkenazi Jewish descent you’re at risk of being diagnosed with prostate cancer.

Metastatic prostate cancer
Ovarian cancer
Male or female breast cancer
Colorectal cancer
Endometrial cancer
Pancreatic cancer
Germline mutations (changes to your DNA that you inherit from the egg and sperm cell during contraception)

When you should get screened for prostate cancer

Age under 40 years

No reason to screen.

Age 40 to 54 years

No screening if you are at “average risk” but you should be screened if:

You have a family history of a first degree relative (sibling or parent) with prostate, breast, ovarian or pancreatic cancer.
You are African American.

Age 55 to 69 years

This is the age group where screening is most important. PSA screening should be a shared discussion with your physician.

Age greater than 70 years