Prostate Cancer Screening

In 2020, approximately 170,000 men will be diagnosed with prostate cancer in the United States. We’ve gotten better at detecting it and treating it, but prostate cancer still accounts for nearly 5% of all cancer deaths. Screening may help to address this problem.

To start off I should explain what screening means. Screening is testing to detect a possible health problem before someone has signs or symptoms. For example, when you turn 50 you should have a screening colonoscopy to look for colon cancer. If someone has blood in their stool the colonoscopy is no longer a screening test, but a diagnostic test. The difference is having symptoms vs no symptoms. Prostate cancer rarely has symptoms, but sometime will have back pain, bone pain, blood in the urine, or difficulty with urination.

When it comes to screening for prostate cancer the key concept is called “shared decision-making.” The doctor should explain why you might consider doing screening or skipping screening. Basically, you should understand the plusses and minuses of screening and you can then decide if it sounds right for you or not.

Prostate cancer screening involves two simple tests. The first is a digital rectal exam where the doctor puts one finger in your rectum to feel the prostate. The exam checks for any lumps or bumps called nodules that may be present. The second test is a PSA blood test. PSA is a protein that is made by normal prostate cells. When prostate cancer is present the number of prostate cells increases rapidly. More cells means a higher PSA value. However, a PSA rise can also happen normally. As a man ages, the PSA value will naturally rise as the prostate gets bigger, so it’s important to understand that there are normal ranges of PSA based on age. For men if their 50s the PSA should be less than 2.5. In their 60s it should be less than 4.5. And in their 70s it should be less than 10.

If either of these tests is abnormal then you should be referred to a urologist for further evaluation.

Now let’s talk about who should be screened for prostate cancer. The American Urologic Association, the biggest influencer on urologic care recommends screening in men aged 55 to 70. Most doctors start at age 50, which is reasonable since that’s also the age several other screening tests start. There are some special cases to consider though.

Men whose prostate cancer risk is above average may consider beginning screening at an earlier age. These risk factors including being black, having a family history of prostate cancer at an early age, or certain other cancers in first-degree relatives that developed at a young age. Men over 70 in excellent health may consider continued screening. Any men who have an estimated lifespan less than 10 years should not be screened. The reason for this is that these men are more likely to die from their other medical problems than from prostate cancer.

To summarize, you should consider prostate cancer screening if you are healthy between the ages of 50 and 70. Testing will include a rectal exam and a blood test. If either of these is abnormal you should see a urologist.

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