Screening for Prostate Cancer

Screening Tests for Prostate Cancer

Screening for prostate cancer is done because early stages of this disease usually do not present with any specific symptoms. If prostate cancer is caught in these early stages then treatment will be more effective than if it was caught when symptoms have arisen.

The American Cancer society recommends testing for prostate cancer for males over the age of 50. For males who are in a high risk group such as those with a family history of prostate cancer, have BPH (benign prostatic hyperplasia or African American males, screening should begin at the age of 40 to 45. These tests should be performed yearly by you physician. Medicare usually covers the costs of screening for males in these age groups, check with you provider to see if you are covered.

The typical screening techniques used for prostate cancer are annual PSA's, DRE's and Transrectal Ultrasounds. The American Urological Association and the American College of Radiology has recommend annual DRE and PSA screening beginning at age 50 and annual PSA screening beginning at age 40 for African-American men and other men with a positive family history of prostate cancer. The American Cancer Society recommends all men over 50 should begin screening if they have a life expectancy of 10 or more years and annual screening for African American males and males who have at least two first degree relatives affected should begin screening exams earlier than 50.



DRE (digital rectal examination) : A digital (finger) rectal examination is done to check for abnormalities of organs or other structures in the pelvis and lower abdomen. During the examination, the doctor will insert a lubricated and gloved finger into the rectum and possibly use the other hand to press on the lower abdomen and pelvis. By doing this it allows the doctor to feel the back part of the prostate and determine its size and if there are firm or irregular areas of the prostate which can be cancerous. A DRE is often done at regular checkups to check the prostate gland. DRE's should be started at ages 40-45 years old at yearly exams for males.

PSA (prostate specific antigen) : is the enzyme that is produced in the prostate. This enzyme is produced in the prostate gland and then is released into the blood. To measure the amount of PSA in the blood a small amount of blood is usually drawn from the arm and tested. A high PSA level does not mean you have prostate cancer, PSA levels can rise due to infections and BPH(benign prostatic hyperplasia). A level of PSA was established to determine a cutoff level between the most benign conditions and the level of PSA when the condition was most likely to be malignant, and that level is 4.0 nanograms per milliliter of serum. If a patient has a PSA of above 4.0 this might cause the physician to order a biopsy of the prostate although talk has begun recently to lower that level to 2.5.
In general the higher the PSA level in the blood the more chances that a prostate condition is present but it is not a guarantee that something is wrong. Many benign factors can effect the PSA levels in males such as race,age, enlargement of the prostate, medical procedures, and certain infections in the prostate. Everybody is different and different people will have different levels of PSA in the blood. The only person who can make the final decision on what your test results actually do mean are you doctor so do not start to worry if your PSA comes back high. Remember even if it is determined that you have prostate cancer in the early stages it is very treatable.

Further Testing

If your tests come back and your physician determines you need further testing, which does happen, do not start to panic. Many men who have to have more tests performed do not have prostate cancer. If after your PSA or DRE are done and your physician determines there might be a problems you will probably be sent to a urologist who will perform additional tests to determine if it actually is prostate cancer or possibly another prostate condition.

The urologist may perform what is called a Transrectal ultrasound. This is a procedure in which a probe that is about the size of a finger is inserted into the rectum to visualize the prostate. The probe is used to transmit sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. Transrectal ultrasound are used to diagnose prostate cancer by visually determining if a tumor is present. Transrectal ultrasounds are also used during the biopsy of prostate cancer and if prostate seeds are implanted. If after further testing the urologist suspects a cancerous prostate then a few tiny samples will be taken from the prostate during a biopsy. The urologist can perform this procedure in their office and then the cells gathered from the samples will be sent to a laboratory for further testing and a final determination. Remember that a biopsy is the be all and end all in this process of diagnosis.