When Is It Time To Stop Being Checked For Prostate Cancer
Its essential to be fully informed about the potential risks of PSA testing, which includecomplications from biopsies and teratments.
The answer depends on your current health and your level of concern about cancer.
Routine PSA testing to check for prostate cancer is no longer recommended for most men. But despite what the experts suggest, many men continue to opt for annual PSA tests. This includes a surprisingly large number of men in their 70s. In a recent study in the journal Cancer, more than half of a group of men 75 and older had PSA tests and biopsies.
These men have placed their hope in the value of early diagnosis and treatment, yet stand to gain less from PSA testing than younger men. Across all ages, routine PSA screening leads to life-saving treatment for cancer in about one in every 1,000 men screened.
Force guidelines: These independent experts on preventive medicine do not recommend PSA screening for prostate cancer in men at any age, due to a lack of definitive evidence that the benefits of PSA testing are greater than the risks.
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Weighing Your Options For Treatment
If you test positive for prostate cancer, you have some options as to what youd like to do about it. Until recently, nearly everyone opted for surgery or radiation, while some patients choose not to undergo treatment, instead opting for active surveillance, during which the cancers are left alone but regularly monitored to be certain that theyre not growing.
Certainly, screening can lead to earlier prostate cancer detection, and with earlier detection, youre eligible for multiple different treatments or active surveillance, said Sia Daneshmand, MD, director of urologic oncology at USC Urology of Keck Medicine of USC and associate professor of urology at Keck School of Medicine of USC. So we encourage patients who are candidates for screening to discuss it with their urologist and/or primary care physician so that we can determine whats the best course of treatment for them.
There also is a new option for those seeking prostate cancer treatment. Its called High-Intensity Focused Ultrasound , which uses ultrasound beams to non-surgically destroy prostate tumors.
How Often Do I Need To Get A Prostate Exam
A prostate exam is a common examination that is used to check on the current condition of the prostate. As men age, the need to monitor prostate health becomes more of a necessity. Unfortunately, many men neglect the task of having periodic examinations of the prostate. Often, this is due to a misunderstanding about the mechanics of the exam, as well as a lack of information about prostate cancer and what the disease can do if left unchecked.
Prostate exams do not require much, other than a visit to the family physician or urologist. The exam takes place in the doctors office, and involves nothing more than a lubricant and a rubber glove. The physician dons the glove, lubricates the index finger, and inserts the finger into the anus. The prostate can be easily examined through the thin walls of the rectum, allowing the physician to check for growths, texture, and any other abnormalities. Generally, the examination takes only a moment or two and is relatively painless.
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What Should I Expect During A Prostate Exam
As mentioned above, there are two types of screenings that your healthcare provider may use to detect prostate cancer: a PSA blood test and a digital rectal exam . Research shows that the PSA blood test is more effective for detecting prostate cancer. However, the DRE can still find cancer in people with normal PSA levels. For this reason, many healthcare providers recommend both.
Neither test confirms you have prostate cancer, which is why theyre considered screening assessments rather than diagnostic tests.
PSA blood test
For this test, your healthcare provider simply draws a sample of your blood and sends it to a lab for analysis. The PSA blood test measures the amount of prostate-specific antigen in your blood.
There is no official cutoff score that can determine whether or not you have prostate cancer. Instead, the results are used as a gauge to determine if more testing is needed.
Digital rectal exam
During a DRE, your healthcare provider inserts a lubricated, gloved finger into your rectum. This way, they can feel your prostate to see if there are any lumps or bumps on the back portion of the gland .
What Happens During A Digital Rectal Exam
Your health care provider will insert a gloved finger into the rectum and feel the prostate for hard, lumpy, or abnormal areas. The test takes only a few minutes to complete.
You may feel slight, momentary discomfort during the test. The procedure does not cause significant pain or any damage to the prostate.
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What Is Screening For Prostate Cancer
Some men get a PSA test to screen for prostate cancer. Talk to your doctor, learn what is involved, and decide if a PSA test is right for you.
Cancer screeningexternal icon means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.
There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.
Are You Seeing Prostate Cancer Becoming More Prevalent In Younger Patients
Its pretty rare. Its less common that men in their 40s have prostate cancer, but, we also are very rarely screening them. The young men who come in to be screened tend to have one of those high-risk features. They most likely had a father who had prostate cancer, so theyre nervous about it. Or theyre African-American, and theyve been flagged by their health care providers.
If youre young, your quality of life is even more important to you right now. We know that, if diagnosed with low-grade prostate cancer, a person will need treatment at some time in life. If we can delay treatmentwhich could negatively impact urinary or sexual functionby several years, then we should do that and obviously discuss that there is a low but possible chance of metastasis developing during that time.
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Who Should Get Screened For Prostate Cancer
Prostate cancer typically starts in men around 55 to 70 years old. For men who are not at a higher risk of developing the disease should begin a conversation with their doctor about getting screened in their fifties and repeat the screening about every two years.
Men who are at higher risk for developing prostate cancer should begin screenings at age 40. Those at higher risk for prostate cancer include:
- Black or African-American men
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What Is A Prostate Cancer Screening Like
A prostate cancer screening can be conducted in one of two ways. The first, a PSA test, is a simple blood draw. The second is a brief rectal exam that takes less than 30 seconds to perform.
“For a screening, if a patient comes and asks for a prostate cancer screening, it begins with a blood test,” said Ehdaie. “It’s a small vial of blood, and then a medical history and physical examination. In the physical examination there will be a digital rectal examination in which the physician’s finger is inserted into the rectum to feel the prostate.”
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There Are Risks To Getting Prostate Cancer Tests And Treatments
If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.
Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.
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Reach Out To Us Today
Prostate screenings are crucial to have so that men can catch any signs of prostate cancer early on. Once a man reaches the ages of 40 and above, it is best that he begins to consult with a doctor about this test.
If you have questions about getting a prostate screening and the importance of them, then reach out to our office so that we can help you further. Give us a call or stop by our office today and wed be happy to assist you in any way that we can.
Request an appointment here: or call Center for Adult Medicine and Preventive Care at for an appointment in our Passaic office.
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What Should I Look Out For
The above recommendations apply to screening only i.e. if youre not experiencing symptoms. For many men, prostate cancer can be symptomless because of the way it grows: youll only notice changes if it grows too close to your urethra, disrupting the urinary process. The symptoms of this include:
- Trouble starting a urine stream
- Having a weak urine stream
- Dribbling at the end of urination
- Urinary retention
- Pain after urination or ejaculation.
If youre experiencing these, you should come in for a prostate exam. However, dont panic: the most common cause of the above isnt cancer its benign prostatic hyperplasia . This is when your prostate naturally grows large enough to block your urinary tract. 50% of men aged 51 60 suffer from it, and the number rises as you age. There are a number of treatment options available, from lifestyle changes and medications to minimally invasive procedures and surgery.
Another cause of these symptoms could be prostatitis, which is when your prostate becomes infected. This usually affects men aged 30 50. Additional symptoms include pain in and around your penis, testes, anus, abdomen or lower back, or erectile dysfunction. Usually, this will improve over time and with treatment.
The other symptoms to look out for are signs that prostate cancer has spread. If the cancer breaks out of the prostate, symptoms could include back, hip or pelvis pain, erectile dysfunction, blood in urine or semen, and unexplained weight loss.
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 To Do If You Are Worried About Prostate Cancer
Talk to your GP if you’re worried about prostate cancer. Or if you have urinary symptoms such as difficulty passing urine. The symptoms don’t mean that you have prostate cancer, but it is important to get them checked.
Adult screening programme Prostate cancerUK National Screening Committee, Last accessed March 20222
Screening for prostate cancer. External review against programme appraisal criteria for the UK National Screening CommitteeUK National Screening Committee, October 2020
Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow upC Parker and others
What Do The Results Mean
PSA levels may be above the baseline for various reasons other than prostate cancer.
Other factors that can raise PSA levels include:
- older age
- an enlarged prostate â because of benign prostatic hyperplasia , for example
- prostatitis, which is inflammation and swelling of the prostate
Also, people with obesity may have lower PSA readings.
In addition, some medications may reduce PSA levels, including:
- 5-alpha reductase inhibitors, which can help treat BPH
- aspirin, which some people take regularly as a blood thinner
- statins, which help manage cholesterol levels
- thiazide diuretics, a kind of water pill that can help reduce high blood pressure
Some herbal medicines and supplements can also lower PSA levels. Tell the doctor about any medications and supplements before undergoing the test.
High PSA levels alone do not indicate cancer. However, if a DRE also reveals changes, a doctor may recommend a biopsy for a more accurate result.
The PCA3 is another test for prostate cancer that doctors use in some circumstances. Find out more.
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What You Need To Know About The Prostate When Should You Get Prostate Exam
The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. During puberty, the body produces semen in a large number of cases, including enlarged prostate. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. This is why the prostate is important to the body. It can be caused by many factors, including infection and inflammation.
A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.
While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.
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Should I Poop Before A Prostate Exam
You dont need to change any bathroom habits prior to your appointment. If you feel like you need to poop before your exam, then its fine to do so. But dont worry if you just dont have the urge. The prostate exam shouldnt make you feel like you need to go.
Theres no need to be embarrassed about fecal matter during your prostate exam. Your healthcare provider is experienced in performing this exam and will do everything to ensure your comfort during the process.
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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.
Prostate cancer is not the only cause of high PSA levels. Find out more about the other causes here.
When Should Men Get A Prostate Exam
According to the American Cancer Society, men and people who were assigned male at birth should have their first prostate exam by age 50. If you have a family history of prostate cancer, you should consider having your first prostate exam at age 45.
Additionally, Black men are at a higher risk for being diagnosed with prostate cancer. For this reason, healthcare providers often recommend that Black men have their first prostate exam around age 45.
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When Should I Call My Healthcare Provider
If youre 50 and you havent had your first prostate exam yet, call your healthcare provider to set up an appointment. If youre at higher risk, such as if you’re Black or prostate cancer runs in your family, you should have your first prostate exam by age 45.
Furthermore, if you develop symptoms of urinary tract obstruction, schedule a visit with your provider right away. This may indicate an enlarged prostate, benign prostatic hyperplasia or a urinary tract infection.
A note from Cleveland Clinic
Most people are understandably apprehensive about their first prostate exam. Learning all you can about the process can help abate any fears or uncertainties you have. Talk to your healthcare provider about your screening options. A prostate exam is the first step in the early detection of prostate cancer and early detection is key to successful treatment.
Last reviewed by a Cleveland Clinic medical professional on 04/04/2022.