Prostate Cancer: Screening and Diagnosis

Doctors commonly use two tests to screen for prostate cancer:

Prostate-specific antigen (PSA) test

The prostate-specific antigen (PSA) test looks for heightened levels of PSA in your blood. Your prostate gland makes PSA. There are always detectable levels of PSA in your blood, but higher levels may indicate cancerous tumors in the prostate.

There’s no PSA level that doctors consider typical. Typical PSA levels can vary throughout your life. But a doctor will usually compare your levels to the traditional benchmark of 4.0 ng/mL to determine whether they’re high enough for concern.

You will typically go to a laboratory facility to have your blood drawn for a PSA test. Here’s how it works:

1. A doctor or lab technician will take blood out of your arm using a small needle. You might feel a quick, sharp sting when the needle goes in. They will cover the insertion site with a bandage.
2. They will send the blood sample to a laboratory for analysis. Results may take up to 2 weeks, but they’re usually available in a few days.
3. You will receive your results through your insurance provider’s website, or a doctor will ask you to visit for an appointment to review your results.

Digital rectal exam

A doctor performs a digital rectal exam (DRE) to feel for abnormalities in and around your prostate gland through the layer of skin between your rectum and prostate.

Your prostate is usually smooth along its outer surfaces. Bumps or growths can indicate the presence of prostate cancer.

Along with a PSA test, a doctor can help confirm a prostate cancer diagnosis by feeling for growths or tumors through the rectum.

Here’s the process for a DRE:

1. A doctor puts on a glove and lubricates the fingers of the glove.
2. They insert a lubricated, gloved finger slowly and gently into your rectum.
3. They move their finger around to feel for bulges, growths, or tissue that’s firmer than usual, or for tender areas.

The American Cancer Society recommends you consult with a healthcare professional about whether to screen for prostate cancer. This shared decision making will take into account your risk factors as well as the benefits and risks of screening.

Here are some of the most common recommendations for prostate cancer screening:

You should be between 55 and 69 years old

People younger than 40 typically have a very low risk of prostate cancer. And people over 70 may experience more risks than benefits of prostate cancer treatment depending on how severe and widespread it is.

You should undergo screening every 2 years

If you don’t have any noticeable symptoms of prostate cancer, a doctor will usually recommend screening every 2 years. It may be more frequent if you have symptoms or a higher risk of prostate cancer.

You can start screening at 40 years old if you’re at high risk

People with a close family member with prostate cancer, such as a parent or sibling, may need earlier screening. Research suggests African American men also have a higher risk of prostate cancer.

Screening for prostate cancer can save lives. But it can also lead to unnecessary diagnoses or tests. For some people, tumors in the prostate grow so slowly, they will never cause symptoms.

The Institute for Quality and Efficiency in Healthcare says that PSA testing prevents 3 out of 1,000 potential deaths from prostate cancer. But it also provides 60 out of 1,000 people with an unnecessary diagnosis. This is called overdiagnosis.

Prostate cancer treatment can have serious side effects, such as urinary problems and erectile dysfunction. In the case of overdiagnosis, people who would not benefit from treatment could unnecessarily experience these side effects.

A positive screening result also means more tests. Tests to confirm prostate cancer, like a needle biopsy, can be invasive, though minimally. A prostate biopsy can also cause side effects, like blood in your semen or an infection.

Talk with a doctor about the pros and cons of screening. Depending on your level of risk, you can decide whether screening is the best path for you.

A PSA test and DRE may not be enough to confirm that you have prostate cancer. If a doctor suspects that you may have prostate cancer, they may perform one of the following tests to confirm the diagnosis:

Biopsy

In a biopsy, doctors insert a small needle into your prostate gland through your skin surface. They will withdraw and remove a small amount of tissue through the needle. They then send the tissue to a lab to analyze and detect any cancerous cells.

Proctoscopy

Proctoscopy uses a small, lighted tube with a camera to check for cancer. A doctor inserts the scope into your rectum to view the area around your prostate. They may also take a biopsy through the proctoscope.

Sigmoidoscopy

Sigmoidoscopy uses a slightly different kind of small, lighted tube with a camera. A doctor inserts it through your anus and into your sigmoid colon to look for abnormalities. This part of your large intestine comes right before your rectum. It can show signs of prostate cancer as well as other tumors or polyps that grow in your colon.

Colonoscopy

If a doctor suspects your prostate cancer has spread or you have other gastrointestinal symptoms, they may perform a colonoscopy. To do this, they will insert a small, lighted tube through your anus to look for tumors, polyps, or other growths in your colon.

If a doctor diagnoses prostate cancer, they will typically determine what stage your cancer is in and what treatment may be most effective.

Staging

Staging refers to how advanced your cancer is. Staging is measured from 1 to 4, with 1 meaning cancer is contained to the prostate and 4 meaning it has spread far beyond the prostate.

Staging is based on the TNM system from the American Joint Committee on Cancer:

• Tumor: how big the tumor is
• Nodes: how many surrounding lymph nodes are affected
• Metastasis: how far the cancer has spread beyond the prostate

A doctor will also consider how high your PSA levels are as well as your Gleason score. This score measures how likely prostate cancer cells are to spread to nearby areas.

Treatment

If a doctor detects your prostate cancer at an early stage, you may not need treatment right away. They may recommend you come back for regular screenings, biopsies, and blood tests to ensure tumors don’t grow or spread. This is called active surveillance.

If your prostate cancer is at stage 2 or higher, here are some other possible treatment options:

• Radical prostatectomy: A surgeon removes your prostate gland.
• Cryosurgery: A doctor uses a probe to insert cold gases into your prostate. These gases destroy cancerous tissue.
• Transurethral resection of the prostate: A doctor inserts a thin scope into your penis and through your urethra. The scope contains a sharp tool the doctor uses to cut away cancerous tissue that may keep you from peeing.
• Radiation therapy: This method applies doses of radiation to your prostate to destroy cancerous tissue.
• Hormone therapy: You take medication to reduce how much testosterone or other androgens your body makes. This can help slow the growth of cancerous tissue in your prostate.
• Immunotherapy: Doctors remove immune cells from your body and expose them to proteins in cancerous prostate cells. The immune cells are now able to fight more effectively against prostate cancer. Your treatment team will then inject the immune cells back into your body.

Prostate cancer outlook is measured using the 5-year relative survival rate. This refers to how many people survive for 5 years after their diagnosis.

The 5-year survival rates for people with prostate cancer depend on how far the cancer has spread:

• Localized: over 99% if cancer is only in the prostate gland
• Regional: over 99% if cancer is only in the prostate and immediately surrounding tissues
• Distant: 31% if cancer has spread beyond the prostate

Early and frequent screening may enable a doctor to detect prostate cancer before it spreads. A 2015 meta-analysis found that screening reduced the risk of death from prostate cancer by 49%.

Prostate cancer is common but is often treatable when found before it spreads and becomes hard to treat or remove.

You can usually start prostate cancer screenings at 55 years old and continue screenings every 2 years until you’re 70. A doctor may recommend screenings as early as 40 years old if you’re at high risk for prostate cancer.