Prostate cancer is the most common type of cancer among men in the United States; the lifetime risk for men getting prostate cancer is 1 in 8 and it mainly impacts those between the ages of 55 and 69. Located beneath the bladder and around the urethra, the prostate is a gland that is part of the reproductive system that creates fluid for the semen.
The prostate is typically the size of a walnut, but it can grow in size as men age. An enlarged prostate makes it more difficult for the male to urinate. Difficulty urinating may also be a symptom of prostate cancer. Other symptoms include irregularities in semen or blood and painful ejaculations.
A number of medical organizations have issued prostate cancer screening guidelines, including the U.S. Preventive Task Force Service, American Cancer Society, American Urological Association and the National Comprehensive Cancer Network. Although each guideline has slight differences, the fundamental premise is that the patient and physician should make a shared decision about when and how to perform prostate cancer screening. Detected early, prostate cancer is curable. While there are benefits to testing, there are risks as well, including going through a testing process that can be invasive and emotionally stressful.
As with other types of cancer, early detection is crucial in fighting this disease and preventing it from spreading to other parts of the body. Some also find peace of mind in diagnosing a problem. The two basic types of screenings are:
- Prostate specific antigen (PSA) test: This is a blood test that measures the level of PSA (a substance created by the prostate) in the blood. Levels vary based on individual medical history, medication and background. Physicians need to have a shared discussion with their male patients aged 45-50 about the availability of PSA testing, its potential benefits, and the potential risks of testing. Each patient needs to make a personal decision whether to undergo PSA testing based on their risk profile and risk aversion. The benefit of PSA testing is that it can reveal an elevated PSA and ultimately detect cancer while it is still curable.
- Digital rectal examination: This involves a medical provider inserting a finger in the patient’s rectum. Although not as sensitive as PSA, palpable abnormalities can be an indicator of cancer. The rectal exam is also a screening exam for colorectal cancer when combined with a fecal occult blood test.
The False Positive Risk. Although the PSA test itself is not particularly dangerous, an elevated PSA would likely initiate a workup that can include a prostate biopsy, prostate MRI, and/or prostate transrectal ultrasound. However, an abnormal PSA may not mean necessarily mean a person has prostate cancer. Diagnostic testing is invasive, and some people are uncomfortable with that. The risk of a false positive also means that many people will undergo additional testing and not have cancer. As with any invasive testing, bleeding, infection and discomfort are risks.
Age Risk. If life expectancy is less than 10 years, prostate cancer screening is not recommended. This means that after age 70, or if life expectancy is less than 10 years, men do not benefit from prostate cancer screening. Of course, a patient and physician may choose to screen for prostate cancer at an older age, but the benefits are significantly reduced, while the complication rate remains unchanged.
Talk to a doctor
Each person’s health is different, so it is best for men to talk with their doctor once they reach 45 to 50 years of age. PSA testing is where the screening process starts. The physician can make recommendations based on symptoms, screenings, and the patient’s personal risk preferences. Patients then need to decide what care pathway best serves their needs.