What Age For Prostate Exams

What Happens After A Psa Test

Once blood is taken, tests are run to assess the PSA level. Normal levels of the protein-specific antigen will typically result in further testing at your discretion. High PSA levels will result in additional tests, such as further prostate gland examination or a biopsy of the prostate, as determined by your doctor. It is important to understand that prostate cancer can be present with a low PSA level and a higher PSA level can be present without cancer.

How Is The Psa Test Used In Men Who Have Been Treated For Prostate Cancer

The PSA test is used to monitor men after surgery or radiation therapy for prostate cancer to see if their cancer has recurred . If a mans PSA level begins to rise after prostate cancer treatment, it may be the first sign of a recurrence. Such a biochemical relapse typically appears months or years before the recurrence causes symptoms.

However, a single elevated PSA measurement in someone who has a history of prostate cancer does not always mean that the cancer has come back. Someone who has been treated for prostate cancer should discuss an elevated PSA level with their doctor. The doctor may recommend repeating the PSA test or performing other tests to check for evidence of a recurrence. The doctor may look for a trend of rising PSA level over time rather than a single elevated PSA level.

A rising trend in PSA level over time in combination with other findings, such as an abnormal result on imaging tests, may lead the doctor to recommend further cancer treatment.

Are Prostate Cancer Screenings Recommended

Absolutely. Screening for prostate cancer is very important and recommended by the American Urology Association for men over 55 years oldâage 40 if they are at higher risk. Prostate cancer is very treatable and early detection of prostate cancer is key to treatment and recovery.

Men should have a conversation with their primary care physician about their personal health to determine the best time for prostate cancer screening.

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What Age Should Men Be Screened For Prostate Cancer

The Prostate Cancer Foundation recommends that Black men or men with a family history of cancer be screened at the age of 40 otherwise, the organization advises getting screened at 45. The American Cancer Society recommends that men at average risk be screened at the age of 50, while men at high risk of developing prostate cancer like Black men and men who have a first-degree relative, like a father or brother, who were diagnosed with prostate cancer before the age of 65, be screened at 45. Men at even higher risk should be screened at 40.

In 2018, the U.S. Preventive Services Task Force issued a recommendation advising men to start talking about screenings with their doctors at the age of 55.

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Should I Have A Prostate Cancer Screening Test

Routine testing for prostate cancer in all men without symptoms is not recommended in New Zealand at present. Being tested for prostate cancer is your choice. Learning about the pros and cons of prostate testing can help you decide if it is right for you.

To help you decide if a prostate check is right for you, the Ministry of Health has developed the Kupe website. It will help you understand the risks, benefits and implications of prostate testing, so you can have an informed conversation with your doctor.

If you are unsure about whether you need to get tested for prostate cancer, contact your GP for a discussion on the risks and benefits of testing.

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Heres How Often You Should Be Getting Your Prostate Checked

Every mans health needs change as they get older, and one of the most important considerations they should remember is a regular prostate exam. While prostate exams have an unpleasant reputation to say the least, they play a critical role in mens health. These routine exams are essential for detecting prostate cancer early, at a time when its most treatable. But how often should a man get a prostate exam? Read on to find out all the answers.

How Common Is Prostate Cancer

In the United States, the risk of a person with a prostate being diagnosed with prostate cancer is 11%. A persons risk of dying from prostate cancer is 2.5%, and the average age that a person is when they die from it is 80.

Your risk for prostate cancer increases if you:

• Are over the age of 50 years old
• Are African American

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When To Get A Prostate Exam

Prostate cancer is a very common cancer in men who are 50 years of age or older. If detected early, the 10-year survival rate of prostate cancer is 98%. As a result, it is absolutely essential that you get a prostate exam at the correct time.

As previously mentioned, the ACS guidelines suggest that men who are 50 years or older should get screened for prostate cancer. However, for men who are at high risk of getting prostate cancer, this exam should be considered at age 45. Major risk factors for getting prostate cancer that might put an individual at high risk include:

• African American ethnicity
• A first-degree relative who was diagnosed with prostate cancer at an early age

If you have more than one first-degree relative that was diagnosed with prostate cancer at an early age, you should consider speaking with your healthcare provider even earlier, at age 40.

What Is A Digital Rectal Exam

The most common way for doctors to check on the health of your prostate is with a DRE. Its a fairly quick and simple procedure.

For the exam, youll bend at the waist while standing or lie on your side with your knees bent toward your chest.

Your doctor will lubricate a gloved finger and gently place it inside your rectum. Theyll press one hand on your prostate, and their other hand will feel your pelvic area. It should only take a few moments.

You may experience momentary discomfort. You may also feel the urge to urinate, especially if your prostate is enlarged or inflamed.

Your doctor will be able to tell you if your prostate seems to be a normal size and shape. In general, a DRE has no risks.

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At What Age Should You Get Screened For Prostate Cancer

The following prostate cancer screening guidelines apply to men expected to live at least ten years.

Men ages 45 to 49 should have a baseline PSA test.

• If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
• If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
• If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test between the ages of 51 and 55.

Men ages 50 to 59 should have their PSA level checked.

• If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
• If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
• If the PSA level is less than 1 ng / mL, men should see their doctor for another PSA test at age 60.

Men ages 60 to 70 should have their PSA level checked.

• If the PSA level is 3 ng / mL or higher, men should talk with their doctor about having a biopsy of the prostate.
• If the PSA level is between 1 and 3 ng / mL, men should see their doctor for another PSA test every two to four years.
• If the PSA level is less than 1 ng / mL, no further screening is recommended.

Men ages 71 to 75 should talk with their doctor about whether to have a PSA test. This decision should be based on past PSA levels and the health of the man.

What Are The Risks Of A Prostate Exam

In the medical community, there is some controversy regarding the risks and benefits of a prostate exam. When a DRE is performed and irregularity is detected, 50% of the time there is prostate cancer and 50% of the time there isnt. The risk, then, becomes over-treatment.

Although not a physical health risk, the possibility of further testing, such as a prostate biopsy or an MRI of the prostate, can be anxiety-provoking.

Overall, the benefits highly outweigh the risks. Patients should discuss the pros and cons of prostate cancer screening with their physician to make the best decision for their health.

As men age, they can face physical, sexual and medical health concerns that have an impact on their everyday lives. Making healthy lifestyle choices, like exercising regularly and eating a healthy diet, along with regular checkups and screening tests can help prevent or lead to early treatment of many mens health threats.

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What Is A Prostate Exam

A prostate exam is a screening method used to look for early signs of prostate cancer. In general, a prostate exam includes a PSA blood test and a digital rectal exam .

During the digital rectal exam portion, your healthcare provider carefully inserts their gloved finger into your rectum. This allows them to feel the edges and surface of your prostate gland to detect any potential abnormalities.

What Is Involved In A Prostate Cancer Screening

• The PSA blood test: Several factors can influence PSA levels found in a blood test. Evidence-based guidelines are updated frequently and help to identify those who are the best candidates for a blood screening. Men should talk with their physician about PSA results and appropriate course of action.
• The digital rectal exam: While the idea of a DRE is daunting to many men, it is actually very simple, quick and results in little to no discomfort. This exam can help physicians feel for irregularities or hard areas that could indicate cancer.

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When To Start Pca Screening

Age

There is no consensus regarding the age at which to initiate PSA-testing . Most guidelines recommend that discussions about PSA screening start around ages 4555 with well-informed men in good health and a life expectancy of at least 1015 years. The core age group in the ERSPC trial started screening between ages 5569. The AUA guideline supports starting screening at age 55 based on the ERSPC trial and because of the risk of overdiagnosis in younger men, but also acknowledge that men at higher risk for PCa can start before 55.

A recent analysis of the U.S. PLCO trial specifically studied characteristics of 151 men who died from PCa within 13 years of follow-up and were randomized to the screening arm. The authors found that more than half of these men were never screened and they were also older at study start than the average participant .

Critical for balancing the benefits and harms of screening, particularly the risk of overdiagnosis, is the age to stop screeningwhich is covered in another article in this issue of TAU . For instance, stopping screening at age 70 can reduce overdiagnosis by 42% .

Risk factors

Albright and colleagues analyzed data from 600,000 men in the population-based SEER registry with information on family history and found that the relative risks of lethal PCa varied with the number of affected first-degree relatives .

Prostate Exams To Screen For Cancer

There are two types of tests that healthcare providers use to screen for prostate cancer:

• A prostate-specific antigen test is a blood test that measures the amount of PSA in the blood. Sometimes, high levels of PSA are linked to prostate cancer.
• A digital rectal exam is a physical examination where a provider places their gloved finger into the rectum to feel the edges of the prostate gland.

It’s normal to feel nervous or even embarrassed about having a digital rectal exam . It will help to know what to expect during a prostate exam and understand why it’s so important to have one.

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The Position Of The Patient

Before explaining the procedure by which the rectal examination is carried out, we are going to tell you about the different positions you can take so that this test passes with maximum comfort, both for you and for the doctor. Normally, depending on your personal characteristics, the doctor will choose one or another position, although if necessary, he may also give you to choose the position in which you feel most comfortable. The three main positions the patient is usually in are:

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What Would You Say To Men Who Dont Want To Get A Prostate Check

A rectal exam is recommended but optional. We recommend both, but if theyll just let you do a blood test, thats better than not doing anything at all.

If concern about the rectal exam is the only reason youre not getting screened, talk to your doctor about it. We can discuss the risks and benefits. None of the evaluation tests are mandatory, but the reason we do that is that it improves our ability to detect cancer. So, if thats why youre not being evaluated, we can talk and decide if we can do other tests.

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The Test Is Often Not Needed

Most men with high PSAs dont have prostate cancer. Their high PSAs might be due to:

• An enlarged prostate gland.
• Recent sexual activity.
• A recent, long bike ride.

Up to 25% of men with high PSAs may have prostate cancer, depending on age and PSA level. But most of these cancers do not cause problems. It is common for older men to have some cancer cells in their prostate glands. These cancers are usually slow to grow. They are not likely to spread beyond the prostate. They usually dont cause symptoms, or death.

Studies show that routine PSA tests of 1,000 men ages 55 to 69 prevent one prostate cancer death. But the PSA also has risks.

Another Option: Digital Rectal Exams

Most prostate biopsies are driven by PSA results. Urologists also use the digital rectal exam, or DRE.

The American Urological Association hasnt recommended rectal exams because there has yet to be a randomized trial in which some men get the rectal exam and some dont. Based on who lives and dies, this would show if rectal exams have value, says Dr. Freedland. Many people, myself included, think they do have value. Its part of the evaluation that we use even if its not officially in our guidelines.

The DRE may cause momentary discomfort, but it can also detect prostate cancer for those patients with normal PSA levels. We use the exam because we think it should work and be helpful, even if it hasnt been studied, Dr. Freedland adds. Most people are screened with PSA and DRE.

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What Is A Dangerous Psa Level

PSA levels are measured as a number of nanograms in each milliliter of fluid tested. This is written as ng/mL.

• PSA level 2.5 ng/mL or lower: This is a normal PSA level for those under age 60, but in some cases, prostate cancer may still be present.
• PSA level between 2.5 and 4 ng/mL: This is a normal PSA level for most people.
• PSA level between 4 and 10 ng/mL: This indicates that prostate cancer might be present. At this level, there is about a 25% chance that you have prostate cancer.
• PSA level 10 ng/mL or above: There is a 50 percent chance that prostate cancer is present. The higher the PSA rises above 10 ng/mL, the greater the chance that you have prostate cancer.

Your doctor may also monitor your PSA velocity, or doubling time, which means recording your baseline PSA the level at your very first PSA test and seeing how fast the PSA level increases over time. Rapid increases in PSA readings can suggest cancer. If your PSA is slightly high, you and your doctor may decide to keep an eye on your levels on a regular basis to look for any change in the PSA velocity.

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How Are Researchers Trying To Improve The Psa Test

Scientists are investigating ways to improve the PSA test to give doctors the ability to better distinguish cancerous from benign conditions and slow-growing cancers from fast-growing, potentially lethal cancers. And other potential biomarkers of prostate cancer are being investigated. None of these tests has been proven to decrease the risk of death from prostate cancer. Some of the methods being studied include

Selected References

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Should I Get Screened For Prostate Cancer

This video helps men understand their prostate cancer screening options.

In 2018, the U.S. Preventive Services Task Force made the following recommendations about prostate cancer screening

• Men who are 55 to 69 years old should make individual decisions about being screened for prostate cancer with a prostate specific antigen test.
• Before making a decision, men should talk to their doctor about the benefits and harms of screening for prostate cancer, including the benefits and harms of other tests and treatment.
• Men who are 70 years old and older should not be screened for prostate cancer routinely.

This recommendation applies to men who

• Are at average risk for prostate cancer.
• Are at increased risk for prostate cancer.