When it comes to cancer, it’s all about managing risk—the older a patient is, and the more personal elements that correlate to having cancer, the earlier a patient needs to consider screening for cancer. In recent years there has been some controversy about early screening for prostate cancer, and last month a study was published that implied that guidelines recommending fewer screenings have led to higher diagnosis of metastatic prostate cancer.
But the facts are that for every seven men, one will be diagnosed with prostate cancer in his lifetime, however, with proper monitoring and treatment, 99 percent of men with common types of prostate cancer survive more than five years after diagnosis.
When it comes to prostate cancer, family history and race play large roles in determining when a man should schedule his first screening for prostate cancer. Doctors recommend that men with multiple first-degree relatives—this includes parents, siblings, and children—diagnosed with prostate cancer should have an initial screening at age 40. For African American men and men of other races who have a parent or sibling who was diagnosed with prostate cancer at an early age, their risk of prostate cancer is high, so they should schedule a screening at age 45. Men who do not fall into the two previous categories should schedule their first prostate cancer exam by the time they reach 50 years of age. If patients are unsure when to consider testing, they can speak with their primary provider who can help them decide.
Once a man determines he is interested in proceeding with a prostate cancer screening, he will make an appointment for a prostate-specific antigen (PSA) blood test. The test measures the levels of PSA proteins—produced in the prostate gland—in the patient’s bloodstream because this elevation in PSA is associated with prostate cancer. Prostate-specific antigens are measured in nanograms per milliliter (ng/mL). Once the PSA blood test results are confirmed, the next step is determined by the results of the test. If the PSA shows 2.5 ng/mL or less, the levels are low enough that the patient only needs to return in two years for another test. If the PSA shows more than 2.5 ng/mL but less than 4.0 ng/mL, the patient should retest annually. If the test is over 4.0 ng/mL, the doctor will likely solicit a biopsy to identify whether prostate cancer is present. A prostate biopsy involves placing hollow needles into the prostate in order to extract tissue samples. These samples are then reviewed by a pathologist for signs of prostate cancer.
However, when a patient exhibits no symptoms of prostate cancer but elicits a high PSA score, the doctor may choose to perform another PSA blood test to confirm the initial findings. Once confirmed, the doctor will continue to test—both PSA blood tests and digital rectal exams (DRE)—watching for continued rises in PSA or suspicious lumps that may appear. If none of these problems occur, the doctor may exam other potential causes for the high PSA score, using tests such as urinary checks, transrectal ultrasounds, x-rays, or cystoscopy.
As with most tests, measuring PSA levels to determine cancer is present relies on multiple factors, so inaccuracies can arise. Although the PSA blood test is used to detect prostate cancer, elevated levels of nanograms could also be caused by prostatitis, benign prostatic hyperplasia (BPH), or even a urinary tract infection, signaling a false positive. If a patient receives a false positive that occurs in subsequent rechecks, he may receive unnecessary medical procedures, which can lead to adverse side effects. In other cases, the PSA levels may read low even though a patient has prostate cancer, causing a false negative. If the doctor believes no cancer is present, there will be no treatment. In some cases, the absence of treatment could cause further complications when the prostate cancer is eventually diagnosed.
When it comes to medical testing, patients should be aware of all the positives and negatives associated with any test they are considering. A thorough discussion with their doctor allows men to determine whether testing is right for their specific circumstance, taking their complete family history, race, activity level, current symptoms, and any other relevant factors into consideration. Overall, PSA screenings at an appropriate time, based on the risk of cancer, are known to successfully assist in diagnosing early stage cancer while minimizing impacts to a patient’s life.