Prostate cancer screening

Prostate cancer screening is a way of looking for the presence of cancer before any noticeable symptoms. Screening is intended to identify the cancer before it spreads to other areas of the body.

There are no universal screening recommendations for prostate cancer, but both the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) recommend that men talk to their health care providers about the benefits and risks of screening so they’re better equipped to make an informed decision.

Recommendations and guidelines

The ACS recommends men should discuss the benefits and risks of prostate cancer screening with their doctors based on the following ages and risk factors:

• From age 40: Men with more than one first-degree relative (father or brothers) who have or have had prostate cancer
• From age 45: Men with a higher risk of prostate cancer, including black men, or men who have a father or brother who were diagnosed with prostate cancer diagnosed before the age of 65
• From age 50: Men with an average risk of developing prostate cancer who have a life expectancy of at least 10 more years

The USPSTF, alternatively, recommends these prostate cancer screening guidelines:

• Men ages 55 to 69: Men should discuss a prostate-specific antigen (PSA) screening with their doctor to make an informed decision.
• Men 70 and older: PSA-based screening isn’t recommended.

Benefits and risks of prostate cancer screening

Most any medical decision comes with benefits and potential risks, and prostate cancer screening is no exception. Prostate cancer may spread to other parts of the body, which may make it more difficult to treat. The benefits of prostate cancer screening include:

• Early diagnosis while the cancer is still small and localized
• The ability to make informed treatment decisions 
• The ability to start treatment before the prostate cancer has the chance to spread (in some patients, this means a lower risk of death)

Some potential risk factors for prostate cancer screening and subsequent treatment include:

• False positives: A PSA result may be abnormal even though cancer isn’t present, which may lead to:
  • Emotional distress
  • An unnecessary prostate biopsy, which may cause side effects, including infection, discomfort and bleeding
• Prostate cancer may be detected in screening but wouldn’t have caused symptoms, but if found and treated, the patient may experience unwanted side effects—which may be long-lasting.
• Prostate cancer treatment itself may also cause side effects, including:
  • Erectile dysfunction
  • Incontinence
  • Bowel problems

The doctor can explain how these benefits and harms may apply to the patient’s health and well-being.

How is prostate cancer screening performed?

Prostate cancer screening may include:

• PSA testing
• Digital rectal exam

If a man decides to be screened for prostate cancer after talking with his doctor, the ACS recommends a PSA test and, in some cases, a digital rectal exam (DRE).

PSA screening for prostate cancer screening

PSA screening is a blood test that measures PSA levels. In some men, PSA levels may be higher than normal when prostate cancer is present. However, PSA levels may also vary due to:

• Infections
• Prostate enlargement (not caused by cancer)
• Certain medications and medical procedures

After a PSA test, the medical team will interpret the results. If further information is needed, a prostate biopsy may be performed. During a biopsy, a tissue sample is removed from the prostate and examined in a laboratory to look for the presence of cancer cells. A biopsy is the only way to definitively diagnose prostate cancer.

Digital rectal exam for prostate cancer screening

The digital rectal exam (DRE) is a lesser-used screening tool. During a DRE, a doctor will insert their finger, using lubrication and a glove, into the rectum to feel the prostate and check for signs of cancer. The USPSTF doesn’t recommend the DRE be used as a primary screening test as the evidence doesn’t suggest it’s beneficial.

It’s understandable that PSA screening may be a complicated decision for patients to make, since the need for the test, and its results, aren’t simple. Patients should discuss their questions and concerns about prostate cancer screening with their health care providers.