Questions men should ask about prostate cancer screening

Just like women are highly encouraged to have a yearly mammogram in order to detect breast cancer, men past the age of 40, are encouraged to have regular prostate cancer screenings. Other than skin cancer, Prostate cancer is the most common type of cancer found in men and is the second leading cause of cancer death in American men, behind lung cancer. 

For the year 2019, the American Cancer Society estimates that in the U.S., around 174,650 new cases of prostate cancer will be diagnosed and about 31,620 men will die from the disease. Throughout the course of a man’s life, about 1 man in 9 will be given a diagnosis of prostate cancer (African American men face a 1 in 3 chance) and about 1 man in 41 will die from this cancer.

While prostate cancer is a serious disease, most men given a diagnosis of it, will not die from it. Over 2.9 million men in the U.S., who have been given a diagnosis of prostate cancer, are alive today, thanks in part, to prostate cancer screenings. Without these important screening tests, many more men may not have been discovered until the disease had metastasized or spread, making it more difficult to treat and increasing the risk of death.

Questions men should ask their doctor about prostate cancer screening

Prostate cancer screening has been debated many times over the years.  There are varying differences of opinion as to when to begin screening for the disease and concerns on over-treating nonaggressive or slow-growing forms of prostate cancer.  To get a clearer picture of what to do, men should ask the following questions of their primary care physician or their urologist:

·      What is prostate cancer?

Prostate cancer is cancer occuring in a man’s prostate – the walnut-sized gland in the male reproductive system. It is located below the bladder in front of the rectum and surrounds the upper part of the urethra, the tube that empties urine from the bladder. The prostate helps regulate bladder control and produces the seminal fluid that nourishes and transports semen.

·      What causes prostate cancer?

It is not known what specifically causes prostate cancer, but there are several risk factors for the disease:

·      Advanced age

·      Being African American

·      Having a father, brother, or son who had  prostate cancer

·      When should I start testing for prostate cancer?

The best place to start when wanting to learn more information about PSA testing is to discuss the matter with your doctor. There is much debate as to what age to start PSA screenings. It is strongly advisable to begin with a baseline PSA screening around age 40.  Men can and do develop prostate cancer younger than the age of 50 and when they do, it can be more aggressive and difficult to treat.  Ask your healthcare provider about the benefits and risks of PSA screening and also be aware of risk factors that can increase your risk for developing prostate cancer, including:

Currently, the U.S. Preventive Services Task Force recommendation on screening for prostate cancer is as follows: Based on a review of the evidence, the Task Force recommends that men aged 55 to 69 years make an individual decision about whether to be screened after a conversation with their clinician about the potential benefits and harms. For men 70 years and older, the potential benefits do not outweigh the expected harms, and these men should not be routinely screened for prostate cancer.

·      What is the test used to screen for prostate cancer?

Prostate specific antigen is a protein produced by normal as well as malignant cells of the prostate gland and is found in the blood.  The PSA test measures the level of PSA in a man’s blood.  For this test, a blood sample is sent to a laboratory for analysis.  The results are usually reported as nanograms of PSA per milliliter (ng/ml) of blood.  The blood sample taken is used to monitor the level of PSA being produced by the prostate. 

The PSA test became available in the early 1990s and is a simple test used to monitor the PSA levels over a period of years.  When this is done regularly, urologists are much better able to detect spikes or elevations in a man’s PSA level.  One aspect looked at is PSA velocity.  PSA velocity is the rate at which a man’s PSA levels change over a period of time.  PSA mapping is the best way to determine if elevations are a cause for concern such as prostate cancer. 

·      Are there factors besides cancer that can influence the outcome of a PSA test?

If a man’s PSA test comes back higher than normal, it does not automatically mean prostate cancer. There can be many other reasons besides prostate cancer affecting a PSA reading including the following:

·      Prostatitis or inflammation of the prostate

·      Urinary tract infection

·      Benign prostatic hyperplasia (BPH) which is an enlargement of the prostate

·      Injury to the prostate

·      Treatments such as prostate biopsies (tissue samples) or cystoscopy which is a test to look inside the urethra and bladder

Results of a PSA test can also be influenced by other factors such as:

·      A man’s age - blood PSA levels tend to rise with age

·      Men with larger prostates make more PSA

·      Change in PSA levels over time (known as PSA velocity) can be markers of both cancer risk and how quickly a cancer may be growing

·      What is a normal PSA level?

There is no specific normal or abnormal level of PSA in the blood, and levels may vary over time in the same man. Most doctors consider anything over 4.0 ng/ml or 4 nanograms per milliliter of blood, as above the typical range.

However, more recent studies have shown that some men with PSA levels below 4.0 ng/ml have prostate cancer while some men with higher levels do not have prostate cancer. In general, the higher a man’s PSA level, the more likely it is a greater likelihood he has prostate cancer and rising levels over time are also a warning sign.

·      How will I know if I need a biopsy?

Based on findings from a PSA test, the decision to have a prostate biopsy should be determined together with your healthcare provider. Other factors to take into consideration include your family history of prostate cancer, your race, results of any prior biopsies, and other major health your issues you may have.

·      If I have prostate cancer, should I see a urologist or oncologist for treatment?

There are several types of doctors who treat prostate cancer which include:

·      Urologists: surgeons who treat diseases of the urinary system and make reproductive system including the prostate

·      Radiation oncologists: doctors who treat cancer with radiation therapy

·      Medical oncologists: doctors who treat cancer with medicines such as chemotherapy or hormone therapy

·      Surgical oncologists: doctors who treat cancer by removing tumors and surrounding tissue during an operation. Surgical oncologists also perform certain types of biopsies.

·      What is my chance of surviving prostate cancer?

While being screened for prostate cancer may sound scary, for the vast majority of men who contract the disease, the majority will survive it.  In fact, the 5-year survival rate for most men with local or regional prostate cancer is nearly 100%.  Ninety-eight percent are alive after 10 years. For men diagnosed with prostate cancer that has spread to other parts of the body, the 5-year survival rate is 30%.

Get screened – not only can it save your life but give you peace of mind in leading a healthy, quality life.