Testing for prostate cancer: Early detection and screening
This article is not intended to replace professional medical care or advice. If you have any questions or need additional information, please talk with your doctor.
The purpose of prostate cancer screening is to detect the disease in its earliest stages before any symptoms may show, as that is when it can be treated most effectively. However, while early detection of prostate cancer is possible, testing is not perfect. Research has yet to prove if the benefits outweigh the risks and thus, researchers and doctors have not yet arrived at a unanimous conclusion.
Is testing the right decision?
According to advocates of regular screening, early detection means early treatment, which could improve the likelihood of curing the cancer. Although tests are not flawless, the exams available today are the most accurate to date, according to the American Cancer Society (ACS). Conversely, most prostate cancers develop relatively slow, leading many to believe that the harmful effects of treatment may outweigh the potential benefits that come from early detection at a stage when the cancer is unlikely to cause any problems in the first place.
There is no tried-and-true answer, and the decision is deeply intricate and personal. The American Cancer Society and the Prostate Cancer Foundation (PCF) have both advised that all men make an informed decision to undergo prostate cancer testing after receiving the most recent and relevant information on the potential benefits, uncertainties and risk factors involved. Decisions to be screened should be based on the individual’s overall health, life expectancy and risk level. Additionally, the choice should depend on whether or not the individual would want to receive treatment if screening were to result in a prostate cancer diagnosis. The decision to be screened for prostate cancer is an extremely personal one.
Prostate cancer screening
There are two different tests used for prostate cancer screening. The prostate-specific antigen blood test (PSA) and the digital rectal exam (DRE) can both be easily done in a physician’s office during an annual visit.
- PSA testing: The PSA test involves drawing a small amount of blood from the arm and measuring the level of PSA – the prostate-produced protein – in the bloodstream. In healthy individuals, the protein is released into the bloodstream in very small amounts. The level for the average male is generally under 4 nanograms per milliliter of blood, according to the PCF. When the prostate develops cancer, that level typically rises above four.Although the chance of having prostate cancer increases as the level of PSA rises, a higher amount in the blood does not necessarily guarantee that a man has cancer. Fifteen percent of men with a PSA below four will still show prostate cancer on a biopsy, reported the ACS. However, PSA levels over 10 means more than a 50 percent chance of prostate cancer.The PSA test is not perfect and levels can be elevated for a variety of reasons. According to the National Cancer Institute, there is no longer a specific normal or abnormal level for PSA in the blood because of these outside factors such as an infection, an enlarged prostate, certain medications or even some medical procedures. Contrarily, some medications can even lower a man’s PSA level. This could lead to a false-negative test result, meaning that the cancer goes undetected because of these low levels.
- DRE exam: The digital rectal exam has been around for a long time. During a DRE exam, the doctor uses a gloved, lubricated finger to examine the prostate through the rectum. The doctor will feel for any irregular shapes, textures or abnormal size. Abnormal findings during this exam include induration, asymmetry and nodules. This type of test is helpful for urologists to differentiate between prostate cancer and conditions that are not cancerous, such as benign prostatic hyperplasia.A limitation to the DRE exam is that not all types of prostate cancer – although the majority can be – are detected by a finger evaluation alone. Often in this case, other diagnostic tests are required. When it comes to measuring the size and extent of a tumor, growths that are nonpalpable will not be able to be felt by the finger alone. Gathering information and input from your doctor will help you make an informed decision on testing.
If a PSA or rectal exam test indicates prostate cancer, a biopsy is usually performed to properly identify whether or not an individual has cancer. A biopsy can be performed relatively quickly on an outpatient basis. It’s done by putting a needle into the prostate gland to remove microscopic pieces of tissue which are then examined for cancerous cells. If the biopsy reveals prostate cancer, the patient and doctor will decide whether or not treatment is necessary, and if it is, how the cancer will then be treated.