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How Do You Screen For Prostate Cancer

Who Is The Psa Test For

How to Test for Prostate Cancer | Ask a Prostate Expert, Mark Scholz, MD

Prostate cancer screening testing is recommended for:

  • Men aged 50-69 who are at average risk for the disease
  • Men who are 45+ years of age and at higher risk for developing prostate cancer either because they are African-American or they have a father, brother, or son diagnosed with prostate cancer before age 65
  • Men who are 40+ years of age with multiple first-degree relatives who have been diagnosed with prostate cancer. This is the highest risk group.

When Should You Start Screening

First, talk to your doctor at your next checkup to go over your particular risk factors. You may have more than one risk factor at play and thus have a greater chance of developing prostate cancer than other men.

In general, discussions with your doctor about screening for prostate cancer should begin in your 40s. Here are some rough guidelines:

Do you have family history of prostate,ovarian, breast, colon, or pancreatic cancers,or do you know that gene mutations are present in your family?Discuss screening with your doctor startingaround age 40.

Prostate Cancer Is The Most Common Nonskin Cancer Among Men In The United States

Prostate cancer is found mainly in older men. Although the number of men with prostate cancer is large, most men diagnosed with this disease do not die from it. Prostate cancer causes more deaths in men than any other cancer except lung cancer. Prostate cancer occurs more often in African American men than in White men. African American men with prostate cancer are more likely to die from the disease than White men with prostate cancer.

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Does Early Prostate Cancer Screening Do More Harm Than Good

Dec. 14, 2021 — Itâs a question that has divided menâs health experts for years: Should healthy men, with no symptoms or family history of prostate cancer, get a prostate specific antigen test and treatment right away if a tumor is found?

Menâs health experts and cancer specialists say the continuing back-and-forth on PSA testing and active surveillance has deepened widespread confusion for men with questions about what to do.

Proponents of routine PSA testing say it is the best screening tool in oncologistsâ arsenals for catching prostate cancer early, when it is most treatable.

But opponents argue that it prompts many newly diagnosed men to seek invasive treatments that can cause impotence and incontinence, although up to 80% have low-risk tumors that will never be life-threatening. For them, they say, the best option is âactive surveillance,â where doctors monitor patients closely for signs their cancer is advancing before treating it.

This fall, the influential National Comprehensive Cancer Network reignited the debate, recommending active surveillance, surgery, or radiation for men newly diagnosed with prostate cancer as a result of PSA testing — giving equal weight to all three approaches.

After a firestorm of criticism, the NCCN reversed course and now recommends that âmost menâ with low-risk prostate cancer be managed through active surveillance as the âpreferredâ first treatment option over surgery and radiation.

Is The Psa Test Recommended For Prostate Cancer Screening

Talking To Your Doctor About Early Stage Prostate Cancer ...

Until about 2008, some doctors and professional organizations encouraged yearly PSA screening for men beginning at age 50. Some organizations recommended that men who are at higher risk of prostate cancer, including African-American men and men whose father or brother had prostate cancer, begin screening at age 40 or 45. However, as more was learned about both the benefits and harms of prostate cancer screening, a number of organizations began to caution against routine population screening. Most organizations recommend that men who are considering PSA screening first discuss the risks and benefits with their doctors.

Currently, Medicare provides coverage for an annual PSA test for all Medicare-eligible men age 50 and older. Many private insurers cover PSA screening as well.

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Guidelines For Urgent Referral

According to the NCCP guidelines, you should ideally get an appointment within 4 weeks if you have certain symptoms. The symptoms are:

  • Abnormalities in your prostate that your GP can feel during a rectal examination
  • A PSA test that is considered high for your age
  • A borderline PSA test, followed by a repeat test 6 weeks later that shows the level is rising
  • A raised PSA reading, together with other symptoms that may be linked to prostate cancer

The symptoms that the guidelines suggest GPs should also consider are:

  • Unexplained weight loss
  • Low back pain or other bone pain
  • Blood in the urine
  • Problems getting an erection

The guidelines say that your GP should offer to do a rectal examination and a PSA test if you have these symptoms.

What Are The Screening Guidelines For Prostate Cancer

The general recommendation for prostate cancer is to start being examined by your doctor and have a PSA test at the age of 50 if youre a man at average risk for prostate cancer. PSA, or prostate specific antigen, is a protein produced by cancerous and non-cancerous tissue in the prostate.

If you have a family history of prostate cancer, or if youre an African American man, you are at higher-than-average risk for prostate cancer. For these men, the recommendation is to start getting tested at age 40. This is so crucial for prostate cancer, because its all about early detection. If we can find it early, we can cure it.

Not enough men are being screened for prostate cancer. We need to get the word out and we need to rectify this.

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Types Of Imaging Studies

If your healthcare provider suspects your cancer might be spreading, they will likely order more imaging tests. A common imaging workup may include a bone scan and a CT scan of the abdomen and pelvis. An MRI might be done as well. Some research centers are also using magnetic MRIs or PET scans to further refine the staging of prostate cancer.

Prostate Cancer Doctor Discussion Guide

Get our printable guide for your next doctor’s appointment to help you ask the right questions.

How Do I Get Screened

What Should You Know About Prostate Cancer Screening?

The gold-standard test for prostate cancer screening is the PSA test.

The PSA test measures levels of prostate-specific antigen in the blood. PSA is a protein produced by the cells of the prostate. Because cancerous cells tend to produce more PSA, a spike in your PSA level may signify a problem, however, there are other benign conditions that may cause an uptick in PSA. Read more here about how to make sure your PSA test is as accurate as possible. If youre having a PSA test, it can often be added on to other blood work you may be having that day, and you may not need a separate blood draw.

Tracking your PSA over time can be valuable to distinguish a temporary increase from a gradual, yet persistent rise. Even if your level is still within normal range, but is higher than it was the last time it was tested, its worth checking further. After a single high PSA result, often the first step is to repeat the test a couple of weeks later to confirm that it is, in fact, elevated. This should be done at the same lab as the previous test, to avoid fluctuations due to different equipment.

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Prostate Cancer Screening Patient Version

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Screening is looking for cancer before a person has any symptoms. This can help findcancer at an early stage. When abnormaltissue or cancer is found early, it maybe easier to treat. By the time symptoms appear, cancer may have begunto spread.

Scientists are trying to better understand whichpeople are more likely to get certain types of cancer. They also study the thingswe do and the things around us to see if they cause cancer. Thisinformation helps doctors recommend who should be screened for cancer, whichscreening tests should be used, and how often the tests should be done.

It is important to remember that your doctor does not necessarilythink you have cancer if he or she suggests a screening test. Screeningtests are given when you have no cancer symptoms. Screening tests may be repeated on a regular basis.

If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.

Prostate Specific Antigen Test

A blood test called a prostate specific antigen test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated in other conditions that affect the prostate.

As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.

PSA levels also can be affected by

  • Certain medical procedures.

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What Is A Psa Test And How Does It Work

PSA is an enzyme which is only made by the prostate and is measured by a blood test.

In addition to prostate cancer, many benign conditions can increase a mans PSA levels. The most commoncauses of PSA elevation are inflammation of the prostate and benign prostatic hyperplasia , or enlargement of the prostate1, so having a high PSA score does not automatically indicate prostate cancer.

Men may elect to get a prostate-specific antigen test as it can be an early sign that cancer may be present. Unfortunately, as PSA is not specific to cancer, many men suffer from needless anxiety and undergo painful and expensive diagnostic procedures to follow up on a PSA rise which is not cancer related.

Determining Whether Prostate Cancer Is Aggressive


If a biopsy sample is found to contain cancer, the pathologist analyzing the specimen takes a deeper look at the cancer cells to determine how aggressive the disease is likely to be.

If the cancer cells appear significantly abnormal and dissimilar from healthy cells under a microscope, the cancer is considered more aggressive and expected to advance quickly. Conversely, cancer cells that look relatively similar to healthy cells indicate that its less aggressive and may not spread as fast.

Prostate cancers are assigned a Gleason score depending on how abnormal the cells look..

Gleason score: Gleason scores range from 2 to 10, going from least to most aggressive prostate cancers.

There are different types of cancer cells in a prostate tumor, so the final Gleason score is determined by adding the scores of the two main areas of the tumor.

First, the primary part of the tumor is assigned a number between 1 and 5. Lower numbers indicate that the cells appear relatively similar to healthy cells, while higher numbers show that the cells are abnormal-looking. Then, another number between 1 and 5 is assigned to describe the second most prevalent area of the tumor.

Finally, the two numbers assigned to the different parts of the prostate tumor are added. So, if most of the tumor is given a 4, and some of the tumor is more aggressive and given a 5, the final Gleason score would be 9.

There are many biomarker tests, including:

  • Oncotype DX® Genomic Prostate Score
  • Prolaris
  • ProMark®

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Healthy People 2030 Target

There is no Healthy People 2030 target related to being screened for prostate cancer. There is a target goal to increase the proportion of men who have discussed the advantages and disadvantages of the PSA test to screen for prostate cancer with their health care provider.

Healthy People 2030 is a set of goals set forth by the Department of Health and Human Services.

Note: Goals are indicated as blue line on Detailed Trend Graphs.

Prostate Cancer: Symptoms Signs And Screenings

  • Prostate cancer is the second leading cancer among American men. To learn more about prostate cancer, read this section.

  • Some warning signs of prostate cancer include a variety of sometimes very subtle symptoms. To learn more about early signs of prostate cancer, read this section.

  • Most cases of prostate cancer have no symptoms, so early detection is dependent on testing. To learn more about how screening is done for prostate cancer, read this section.

  • Although there are benefits to detecting prostate cancer early, there can also be some problems. To learn more about the benefits and possible drawbacks of prostate cancer screening, read this section.

Cancer has become a word feared by many people, perhaps because of its association with being untreatable and often fatal. Many people view cancer as something that cant be cured or controlled. But this is far from the truth. There are many different types of cancer, most of which can be treated. New treatments for cancer, including prostate cancer, are being developed every day. Most men who have prostate cancer show no symptoms at first, so early screening plays an important role in its detection, especially for those who are at increased risk of developing it. Even after a diagnosis of prostate cancer, most men survive for 5 years or longer.

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Can You Prevent Prostate Cancer

There are three things that we know can cause prostate cancer:

  • Genes: You cant control your genes. Those come from your mom and dad. But there is a genetic test that can tell you whether you are at average, above average or really high risk for prostate cancer. A man who has a family history can determine if it is genetically based. We can use that knowledge to guide our screening and testing.
  • Diet: Eat in moderation. Dont overdo the fats, proteins, red meats. Eat colorful fruits, vegetables and whole grains. A healthy diet may help reduce your risk.
  • Lifestyle: Some studies have shown that men who are overweight or obese are at higher risk for developing prostate cancer. We live in a stressful society. Particularly, urban societies, like St. Louis, have been associated with a higher risk of prostate cancer. We need to take a more holistic approach to doing the right things to be gentle with ourselves and each other.

How Do You Screen For Prostate Cancer

When To Screen For Prostate Cancer

One way of screening for prostate cancer is with a PSA test. This measures the level of PSA in your blood. There are other types of tests that can help us diagnose prostate cancer, including new imaging technologies. MRI scans and other types of next gen imaging can help us find prostate cancer early in the game while the treatment options are most effective.

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Screening: Safe And Painless Way To Detect Prostate Cancer

A simple blood test called a prostate specific antigen test and a digital rectal exam are currently the best screening methods available for prostate cancer. Prostate cancer screening is safe and painless and can detect prostate cancer early, when it is most treatable.

However, prostate cancer screening is not for everyone. You should know:

  • Some prostate cancers are slow-growing and there is a chance that slow-growing disease may never affect a mans health.
  • Prostate cancer screening detects the presence of cancer it will not show if a cancer is slow-growing or aggressive. Only a qualified physician can make that determination.
  • The test result could be inaccurate or unclear, leading to unnecessary anxiety, another test, or a biopsy or treatment you dont need. Talk to your doctor about benefits and risks before you decide to be screened.
  • Treatment can be life-saving. However, it may cause temporary or long-lasting side effects, such as incontinence or erectile dysfunction
  • If a screening shows you have prostate cancer, its important to talk with a prostate cancer specialist who can help you evaluate your options and make the choice thats right for you.

Before you decide to be screened, talk with your doctor about whether and when prostate cancer screening is right for you. If you dont have a doctor, please call 1-800-DOCTORS. Well be happy to help.

Positron Emission Tomography Scan

A PET scan is similar to a bone scan, in that a slightly radioactive substance is injected into the blood, which can then be detected with a special camera. But PET scans use different tracers that collect mainly in cancer cells. The most common tracer for standard PET scans is FDG, which is a type of sugar. Unfortunately, this type of PET scan isnt very useful in finding prostate cancer cells in the body.

However, newer tracers, such as fluciclovine F18, sodium fluoride F18, and choline C11, have been found to be better at detecting prostate cancer cells.

Other newer tracers, such as Ga 68 PSMA-11 and 18F-DCFPyl , attach to prostate-specific membrane antigen , a protein that is often found in large amounts on prostate cancer cells. Tests using these types of tracers are sometimes referred to as PSMA PET scans.

These newer types of PET scans are most often used if its not clear if prostate cancer has spread. For example, one of these tests might be done if the results of a bone scan arent clear, or if a man has a rising PSA level after initial treatment but its not clear where the cancer is in the body.

The pictures from a PET scan arent as detailed as MRI or CT scan images, but they can often show areas of cancer anywhere in the body. Some machines can do a PET scan and either an MRI or a CT scan at the same time, which can give more detail about areas that show up on the PET scan.

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