Is prostate cancer screening right for you?

 Deciding whether to undergo prostate cancer screening involves understanding the benefits and risks. DiRx explains the PSA blood test and digital rectal exam (DRE), highlighting the importance of discussing personal risk factors and screening results with your healthcare provider. Making an informed decision requires considering your age, race, family history, and potential outcomes of screening and treatment.

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Screening means checking for a health problem before a person has symptoms. This can sometimes help find diseases, like certain cancers, early. Finding and treating cancer early, when it’s small and hasn’t spread, may improve the chance that treatment will work better. But it’s still not clear exactly how helpful screening is for prostate cancer.

There is no standard test to screen for prostate cancer. However, two tests that are commonly used to screen for prostate cancer are described below.

• PSA blood test. A blood test called a prostate specific antigen (PSA) 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, certain medications, an enlarged prostate or a prostate infection.

  Because many factors can affect PSA levels, your healthcare provider is the best person to interpret your PSA test results. If the PSA test is abnormal, your doctor may recommend a biopsy to find out if you have prostate cancer.

• Digital rectal exam (DRE). In this exam, the healthcare provider puts a lubricated, gloved finger into the rectum to check the size of the prostate and feel for lumps or abnormal areas. Some experts, including the U.S. Preventive Services Task Force does not recommend DRE as a screening test because of lack evidence on the benefits.

There are currently varying recommendations as to whether all men have the same benefits from PSA testing. Most expert medical groups agree that routine prostate cancer screening should not be done for all men. But the advice varies between experts.

For example:

• U.S. Preventive Services Task Force (USPSTF) says that men ages 55 to 69 should talk with their healthcare providers about the possible benefits and harms of screening to make an informed decision.

• American Urological Association says that men ages 55 to 69 at average risk for prostate cancer talk with their healthcare providers about being screened. Men at higher risk could have this talk earlier.

• National Comprehensive Cancer Network says that men talk with their healthcare providers about the pros and cons of screening starting at age 45. Men at high risk should have this talk at age 40.

• American Society of Clinical Oncology says that men expected to live at least 10 years should talk with their healthcare providers about whether screening is right for them.

• American Cancer Society (ACS) says that men should talk with their healthcare providers about the pros and cons of screening. They recommend having this talk at age 50 for men at average risk who are expected to live for 10 years or more. Men who are African American or who have a first-degree relative (father, brother or son) diagnosed with prostate cancer before age 65 are at high risk and should have this talk at age 45. The ACS recommends that men discuss screening at age 40 if they are at even higher risk. This means having more than one first-degree relative diagnosed before age 65.

Why do healthcare providers have inconsistent recommendations for prostate screenings?

• PSA test results aren’t always right. In some cases, the PSA test can have false-positive or false-negative results. A false positive means that test results show that a man may have cancer when he doesn’t. This occurs when a man has an abnormal PSA test but does not have prostate cancer. According to the Centers for Disease Control and Prevention, false positive test results often lead to unnecessary tests, like a biopsy of the prostate. They may cause men to worry about their health. Older men are more likely to have false positive test results.

• Finding prostate cancer early may not be helpful. Screening finds prostate cancer in some men who would never have had symptoms from their cancer in their lifetime.