One in eight men will get prostate cancer in their lives, but only one in 44 will die from it. Thanks to improved prostate cancer screening, this disease is being found in more men at an earlier stage, making it more treatable and survivable.
“Prostate cancer does not often present with symptoms, especially when found early, so the best chance of catching it in its most treatable stage is by getting screened,” says Bradley Webster, MD, PhD, a urologist at Roswell Park Comprehensive Cancer Center.
Currently, Roswell Park recommends screening for men aged 45-69, with earlier screening being highly recommended for men who are African American, Ashkenazi Jewish, have a family history of prostate cancer or have a known genetic mutation in their family, such as BRCA, ATM or others.
“These factors may place a man at higher risk for earlier onset and aggressive prostate cancer,” says Dr. Webster. “However, Roswell Park recommends all men get screened between the ages of 45-69.”
PSA screening test is the gold standard
Urologists use several methods to determine whether someone is likely to have prostate cancer. The most accurate test is the prostate-specific antigen (PSA) test combined with a digital rectal exam (DRE). The PSA test was pioneered at Roswell Park by T. Ming Chu, PhD, DSc, in the 1970s. It became the gold standard test in the 1990s and continues to be the preferred blood test for screening men for possible prostate cancer.
PSA measures a specific protein that’s normally made by the prostate gland. However, PSA levels in the blood increase when someone has prostate cancer, an infection, or non-cancerous conditions such as benign prostatic hypertrophy (BPH). Since elevated PSA levels are not directly a sign of cancer, a digital rectal exam is also given.
A DRE involves a doctor gently inserting a finger into your rectum to check for any lumps or other irregularities that might be signs of prostate cancer. When put together, these tests are the most effective combination for screening for prostate cancer.
“I’ve seen cases where the PSA level is normal, but the DRE was abnormal, and prostate cancer was found,” adds Dr. Webster.
Further testing may be required
It is important to remember this test alone will not determine whether you have prostate cancer. Abnormal results may lead your doctors to request imaging tests, like an MRI and possibly a prostate biopsy. Those will ultimately determine if you have prostate cancer. If you are diagnosed with prostate cancer, the biopsy will determine your Gleason score, which grades your cancer (determining whether its risk to your health is high or low) and helps direct the type of treatment options that are best for you.
Not all prostate cancers need treatment
The success and effectiveness of the PSA test means many early-stage, slow-growing prostate cancers also are detected. For many men, these low-risk cancers are unlikely to grow, spread or harm their health. Active surveillance (also called watchful waiting) where the cancer is monitored carefully is often a recommended option. Treatment can be safely delayed, perhaps avoided, and initiated only if the cancer begins to grow or cause other problems.
