Why Is Prostate Cancer Screening Important
“The mortality rate of prostate cancer becomes much higher when it’s found late,” warns Dr. Miles. “Caught in the early stages, however, it’s a disease that’s easily treated, easily controlled though this does mean we need to find it before it’s progressed.”
And that’s where prostate cancer screening comes in, a way of detecting prostate cancer early before symptoms begin, when it’s most treatable. It helps reduce the chance of the cancer spreading or requiring aggressive treatment.
Harms Of Early Detection And Treatment
The harms of screening for prostate cancer include harms from the PSA screening test and subsequent harms from diagnosis and treatment. Potential harms of screening include frequent false-positive results and psychological harms. One major trial in men screened every 2 to 4 years concluded that, over 10 years, more than 15% of men experienced at least 1 false-positive test result.5 Harms of diagnostic procedures include complications of prostate biopsy, such as pain, hematospermia , and infection. Approximately 1% of prostate biopsies result in complications requiring hospitalization. The false-positive and complication rates from biopsy are higher in older men.3 Adequate evidence suggests that the harms of screening and diagnostic procedures are at least small.
PSA-based screening for prostate cancer leads to the diagnosis of prostate cancer in some men whose cancer would never have become symptomatic during their lifetime. Treatment of these men results in harms and provides them with no benefit. This is known as overdiagnosis, and follow-up of large randomized trials suggests that 20% to 50% of men diagnosed with prostate cancer through screening may be overdiagnosed.3 Overdiagnosis rates would be expected to increase with age and to be highest in men 70 years and older because older men have high risk of death from competing causes.
Craig Melvin And Al Roker Premiere ‘get Checked’ Psa
Dr. Matthew Rettig, the medical director of the Prostate Cancer Program at the Institute of Urologic Oncology at UCLA in California, said that even if screenings aren’t performed right away, men should at least start talking about them with their doctors early in life.
“I think I would have that conversation fairly early on in life, maybe even in 30s or 40s, about when to initiate screening,” said Retting. “I think that would be most important for patients who are at high risk for prostate cancer and high risk for early onset of prostate cancer. Those are the types of patients that probably ought to have the discussion and make a decision about when to start screening at a relatively young age.”
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What Does The Psa Test Involve
The PSA test involves taking a blood sample and sending it to a laboratory for analysis. The results indicate:
- Normal levels: Most healthy adult males have PSA levels below 4 nanograms per milliliter .
- Borderline levels: PSA levels of 410 ng/ml are borderline. There is a 25% chance that cancer is present, and the person will usually need additional tests.
- High levels: If PSA levels are over 10 ng/ml, there is a 50% chance that the person has prostate cancer. The specialist will likely recommend more testing, including a prostate biopsy.
It is important to note that PSA levels can naturally vary from person to person. A person with high levels may not have prostate cancer. On the other hand, about 15% of people who test positive for prostate cancer after a biopsy have PSA levels below 4 ng/ml.
Should I Get Screened For Prostate Cancer
This video helps men understand their prostate cancer screening options.
In 2018, the U.S. Preventive Services Task Force made the following recommendations about prostate cancer screening
- Men who are 55 to 69 years old should make individual decisions about being screened for prostate cancer with a prostate specific antigen test.
- Before making a decision, men should talk to their doctor about the benefits and harms of screening for prostate cancer, including the benefits and harms of other tests and treatment.
- Men who are 70 years old and older should not be screened for prostate cancer routinely.
This recommendation applies to men who
- Are at average risk for prostate cancer.
- Are at increased risk for prostate cancer.
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At What Age Should You Get Screened For Prostate Cancer
The following prostate cancer screening guidelines apply to men expected to live at least ten years.
Men ages 45 to 49 should have a baseline PSA test.
- If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
- If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
- If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test between the ages of 51 and 55.
Men ages 50 to 59 should have their PSA level checked.
- If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
- If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
- If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test at age 60.
Men ages 60 to 70 should have their PSA level checked.
- If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
- If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
- If the PSA level is less than 1 ng / mL, no further screening is recommended.
Men ages 71 to 75 should talk with their doctor about whether to have a PSA test. This decision should be based on past PSA levels and the health of the man.
What Age Should I Get A Prostate Exam
Prostate exams are an essential basic health screening test that everyone at risk of prostate cancer should consider. Current American Cancer Society guidelines suggest that men over the age of 50 should speak with their primary care physician about getting screened routinely for prostate cancer. This guideline may change depending on your risk for prostate cancer.
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Cancer Screening Guidelines By Age
The choices you make about diet, exercise, and other habits can affect your overall health as well as your risk for developing cancer and other serious diseases.
Its also important to follow recommendations for cancer screening tests. Screening tests are used to find cancer in people who have no symptoms. Regular screening gives you the best chance of finding cancer early when its small and before it has spread.
Health care facilities are providing cancer screening during the COVID-19 pandemic with many safety precautions in place. Learn how you can talk to your doctor and what steps you can take to plan, schedule, and get your regular cancer screenings in Cancer Screening During the COVID-19 Pandemic.
The tabs below provide information on healthy lifestyle choices that can help lower your cancer risk, and cancer screening test recommendations by age.
How Do I Get Tested
A general practitioner or an urologist can perform a full prostate cancer exam. This should include a PSA blood test and a digital rectal exam .
A Prostate-Specific Antigen blood 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.
A Digital Rectal Exam is a physical exam that is done when a doctor or nurse inserts a gloved, lubricated finger into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities.
Talk to your general doctor or urologist about receiving a prostate exam. If you do not have a doctor, do not have insurance, or cannot afford a test, find out what free screenings are available in your area on our Free Testing Map. If you do not see a free screening in your area, check back in the fall. Many screenings occur in September, during Prostate Cancer Awareness Month.
Recent research has yielded additional tests that in addition to the PSA test and DRE and biopsy that can give a doctor more information on to determine the probability of both finding cancer during a biopsy and determining how aggressive that cancer is likely to be. Learn more here.
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Living With Prostate Cancer
As prostate cancer usually progresses very slowly, you can live for decades without symptoms or needing treatment.
Nevertheless, it can affect your life. As well as the possible side effects of treatment, a diagnosis of prostate cancer can understandably make you feel anxious or depressed.
You may find it beneficial to talk about the condition with your family, friends, a GP and other people with prostate cancer.
Financial support is also available if prostate cancer reduces your ability to work.
How Should I Prepare For The Exam
Your blood must be sent to a laboratory for analysis, so your PSA results wont be available immediately. Your doctor will let you know when they have the results.
The lab report will show the level of PSA in your blood as:
In addition to looking at the amount of PSA in your blood, your doctor will assess how quickly this number is changing. Many things can affect PSA, so test results require careful analysis by an expert. Your doctor will take all of your health information into account.
If you have an abnormal PSA test result, it doesnt mean you have prostate cancer. Most men with a high PSA level dont have prostate cancer. About 25 percent of men who have a biopsy due to a high PSA level have prostate cancer.
Its also possible for men with prostate cancer to have normal DRE and PSA test results.
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Am I At Risk Of Prostate Cancer
In the UK, about 1 in 8 men will be diagnosed with prostate cancer in their lifetime. We don’t know exactly what causes prostate cancer but there are some things that may mean you are more likely to get it these are called risk factors.
There are three main risk factors for getting prostate cancer, which are things you can’t change. These are:
- getting older it mainly affects men aged 50 or over
If you have any of these risk factors or if you have any symptoms, speak to your GP. They can talk to you about your risk, and about the tests that are used to diagnose prostate cancer. You can also get in touch with our Specialist Nurses, who can help you understand your risk of prostate cancer.
Nursing Allied Health And Interprofessional Team Monitoring
One of the major concerns regarding prostate cancer screening is overdiagnosis, which involves overtreatment of low-grade prostate cancer and decreasing the quality of life of the patient by adding treatment-associated side effects and psychological harm when in reality, cancer would not have caused any clinical problems in the patient. This outcome can be overcome by active surveillance . Active surveillance is one of the management strategies in which a super select group of low-grade cancer patients are under close monitoring and followed through their disease course with the expectation to intervene only if cancer progresses. This approach will lead to the avoidance of treatment-associated side effects in such patients. This monitoring is only achievable by cumulative efforts and coordination of care amongst the interdisciplinary team members.
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When To Get Your Prostate Checked: Warning Signs And Advice
A healthy prostate plays a vital role in male fertility, producing fluid that helps keep sperm alive. But as you get older, particularly after the age of 40, you may find that your prostate starts to cause you problems. One reason for this is that the prostate continues to grow as you age. This is a normal process but for many men, an enlarged prostate can cause symptoms that affect their quality of life. This isnt the only problem that affects the prostate, there are several other prostate issues, which can produce similar symptoms to each other. A prostate exam can help you find out whats going on with your prostate so your doctor can then help you get relief from any symptoms you may be experiencing.
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Prostate Cancer Screening Ages 55 To 69
This is the age range where men will benefit the most from screening.Thats because this is the time when:
- Men are most likely to get cancer
- Treatment makes the most sense, meaning when treatment benefits outweigh any potential risk of treatment side effects
Most men will get prostate cancer if they live long enough. Some prostatecancers are more aggressive others can be slow-growing. Doctors will takeyour age and other factors into consideration before weighing the risks andbenefits of treatment.
You should ask your doctor how often he or she recommends you get screened.For most men, every two to three years is enough.
Depending on the results of your first PSA test, your doctor may recommendyou get screened less frequently.
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Use In Men Who Might Have Prostate Cancer
The PSA blood test is used mainly to screen for prostate cancer in men without symptoms. Its also one of the first tests done in men who have symptoms that might be caused by prostate cancer.
PSA in the blood is measured in units called nanograms per milliliter . The chance of having prostate cancer goes up as the PSA level goes up, but there is no set cutoff point that can tell for sure if a man does or doesnt have prostate cancer. Many doctors use a PSA cutoff point of 4 ng/mL or higher when deciding if a man might need further testing, while others might recommend it starting at a lower level, such as 2.5 or 3.
- Most men without prostate cancer have PSA levels under 4 ng/mL of blood. Still, a level below 4 is not a guarantee that a man doesnt have cancer.
- Men with a PSA level between 4 and 10 have about a 1 in 4 chance of having prostate cancer.
- If the PSA is more than 10, the chance of having prostate cancer is over 50%.
If your PSA level is high, you might need further tests to look for prostate cancer.
To learn more about how the PSA test is used to look for cancer, including factors that can affect PSA levels, special types of PSA tests, and what the next steps might be if you have an abnormal PSA level, see Screening Tests for Prostate Cancer.
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Effectiveness Of Early Detection
Potential Benefits of Screening
To understand the potential benefits of PSA-based screening for prostate cancer, the USPSTF examined the results of the ERSPC, PLCO, and CAP trials and site-specific reports from 4 ERSPC trial sites. To understand the effectiveness of treatment of screen-detected, early-stage prostate cancer, the USPSTF also examined the results of 3 randomized trials and 9 cohort studies.3
The ERSPC trial randomly assigned a core group of more than 160,000 men aged 55 to 69 years from 7 European countries to PSA-based screening vs usual care.8 Four ERSPC sites reported on the cumulative incidence of metastatic prostate cancer. After a median follow-up of 12 years, the risk of developing metastatic prostate cancer was 30% lower among men randomized to screening compared with usual care . The absolute reduction in long-term risk of metastatic prostate cancer associated with screening was 3.1 cases per 1000 men.11 After a median follow-up of 13 years, the prostate cancer mortality rate among men aged 55 to 69 years was 4.3 deaths per 10,000 person-years in the screening group and 5.4 deaths per 10,000 person-years in the usual care group .8 The ERSPC trial did not find a reduction in all-cause mortality.8
Neither the ERSPC, PLCO, or CAP trials, nor any of the ERSPC site-specific analyses, found an overall all-cause mortality benefit from screening for prostate cancer.
Potential Benefits of Treatment
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A Cancer Prevention Plan For Men
Finding cancer early improves your chances of successful treatment and long-term survival.
Look for:
- lumps, sores or ulcers that donât heal
- unusual changes in your testicles changes in shape, consistency or lumpiness
- coughs that donât go away or show blood, a hoarseness that persists
- weight loss that canât be explained
- moles that have changed shape, size or colour, or bleed, or an inflamed skin sore that hasnât healed
- blood in a bowel motion
- persistent changes in toilet habits
- urinary problems or changes.
These symptoms are often related to more common, less serious health problems. However, if you notice any unusual changes, or these symptoms persist, visit your doctor.
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When Is A Psa Test Needed
If you are age 50 to 74, you should discuss the PSA test with your doctor. Ask about the possible risks and benefits.
Men under 50 or over 75 rarely need a PSA test, unless they have a high risk for prostate cancer.
- You are more likely to get prostate cancer if you have a family history of prostate cancer, especially in a close relative such as a parent or sibling.
- Your risks are higher if your relative got prostate cancer before age 60 or died from it before age 75. These early cancers are more likely to grow faster.
- If you have these risks, you may want to ask your doctor about getting the PSA test before age 50.
This report is for you to use when talking with your healthcare provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.
04/2014
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