Screening Tests for Prostate

Prostate cancer is the second leading cause of death in men after lung  cancer, and the most common cancer in men. Fortunately, since most prostate  cancer is slow growing, only 30 percent of men diagnosed with prostate cancer  will die from it. So far, research has not confirmed that early detection of  prostate cancer leads to treatment that will prolong life. Testing is needed to  screen for prostate cancer to improve treatment.

There are two methods used to screen for prostate cancer in men. First there  is a blood test used to measure PSA (prostate specific antigen), a protein  produced by the prostate gland. PSA levels tend to rise when prostate cancer is  present. Unfortunately, the test has both high false positives and high false  negatives making results questionable. The test also cannot distinguish if the  prostate cancer is slow growing and unlikely to cause symptoms, or a highly  aggressive form. The other important screening test is the digital rectal exam  (DRE), where a doctor inserts a gloved finger into the rectum to feel for lumps  or irregularity of the prostate. The DRE has an 85 percent false positive rate,  where abnormalities felt but cancer is not present. If either the PSA or DRE is  abnormal, further evaluation is warranted. A prostate biopsy may need to be  performed, using a needle, which is inserted into the prostate through the  rectum. Biopsy is the only truly effective test that can prove if cancer cells  are present.

Prostate cancer can be treated by a variety of means. The treatment decision  must be based on the appearance and spread of the cancer, general health  condition, one's symptoms, and how each individual weighs the potential risks of  the different therapies offered. No therapy has yet proven to extend life,  although some treatments may reduce symptoms making life much more bearable.  Options include watchful waiting, radiation therapy, prostatectomy, and hormone  therapy. Each option has potential and serious side effects.

PSA screening should be optional for men at average risk of contracting  prostate cancer. Advice varies for when PSA are beneficial, and when PSA  screening are recommended. The American Cancer Society and American Urological  Association both recommend offering PSA screening to men ages 50 to 70 at  average risk, with appropriate counseling. African American men and men with  family members who have developed prostate cancer before age 70 are at much  higher risk. These men should discuss prostate-cancer screening with their  doctors.