What Is Cancer Screening
Screening means testing people for early stages of a cancer, or for early changes that could develop into cancer if left untreated. For screening to be useful the tests:
- need to be reliable at picking up cancers that need treatment
- overall must do more good than harm to people taking part
- must be something that people are willing to do
Screening tests are not perfect and have some risks. The screening programme should also be good value for money for the NHS.
Is The Psa Test Recommended For Prostate Cancer Screening
Beginning around 2008, as more was learned about both the benefits and harms of prostate cancer screening, a number of professional medical organizations began to caution against routine population screening with the PSA test. Most organizations recommend that individuals who are considering PSA screening first discuss the risks and benefits with their doctors.
Some organizations do recommend that men who are at higher risk of prostate cancer begin PSA screening at age 40 or 45. These include Black men, men with germline variants in BRCA2 , and men whose father or brother had prostate cancer.
In 2018, the United States Preventive Serves Task Force updated its recommendation statement for prostate cancer screening from a D to a C in men ages 55 to 69. The updated recommendation, which applies to the general population as well as those at increased risk due to race/ethnicity or family history, is as follows:
- For individuals ages 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one. Before making the decision, a person should discuss the potential benefits and harms of screening with their clinician and consider these in the context of their own values and preferences.
- PSA-based screening for prostate cancer is not recommended for individuals 70 years and older.
Specialist Referral And Biopsy
Your doctor will discuss your prostate check results with you. If the PSA and DRC results suggest you have a high risk for prostate cancer, your doctor will refer you to a urologist .
The specialist will discuss having a prostate biopsy, in which a small sample of your prostate gland cells are taken for examination.
The aim of the biopsy is to confirm whether or not you have prostate cancer and, if so, whether it needs treatment. The treatment options will then be discussed with you.
If the biopsy shows no evidence of cancer, you may be advised to attend future check-ups.
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When Should I Have A Prostate Check
Generally, if you aged 50 years or older and have any urinary symptoms, you should let your doctor know. They will discuss with you whether or not you should have a prostate check.
Symptoms include:
- poor flow of urine
- trouble stopping peeing
- dribbling after you are done peeing
- needing to pee more often, at night or urgently
- trouble starting peeing
- incontinence
- pain when peeing
- blood in your pee.
If you have no symptoms, it is recommended that you get checked if you:
- you are a man aged 5070 years old but dont have any family history
- you are a man aged 4070 years old and your father or brother has had prostate cancer
- you are a man aged more than 70 years old and you have family history of prostate cancer or you have had an abnormal PSA test previously, and you have a life expectancy of more than 10 years.
Having a prostate check is your decision. The tests for prostate cancer can be uncomfortable but they may reduce your chance of being harmed or dying from prostate cancer.
If your test results suggest you are at risk of cancer, you will need to decide whether to have further testing and possibly treatment. In making this decision, you will need to consider whether your quality of life will be better living with a slow growing cancer than having treatments, which may cause you more harm than the cancer ever will.
Your doctor can help you weigh up the benefits and risks of being tested, by taking into consideration factors such as your age and family history.
How Is Prostate Cancer Detected
There is no single test to detect prostate cancer. The two most common tests are the prostate specific antigen blood test and the digital rectal examination .
The PSA test measures the level of PSA in your blood. It does not specifically test for cancer. Virtually all PSA is produced by the prostate gland. The normal range depends on your age. A PSA above the typical range may indicate the possibility of prostate cancer. However, two-thirds of cases of elevated PSA are due to noncancerous conditions such as prostatitis and BPH.
A DRE is generally conducted by a urologist to feel the prostate. While DRE is no longer recommended as a routine test for men who do not have symptoms of prostate cancer, it may be used to check for any changes in the prostate before doing a biopsy.
If either of these tests suggest an abnormality, other tests are necessary to confirm a diagnosis of prostate cancer, usually a magnetic resonance imaging scan and transrectal ultrasound biopsy.
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Prostate Exam Vs Colonoscopy: Whats The Difference
At first glance, it might seem that a prostate exam is similar to a colonoscopy. After all, both exams involve your rectal area. However, these two tests are quite different.
While a prostate exam involves feeling the prostate with a gloved finger, a colonoscopy examines the walls of your colon by inserting a flexible camera into your rectum. The prostate is not examined at all during this procedure unless your healthcare provider manually performs an exam.
A prostate exam is a fairly quick procedure performed in an office setting. A colonoscopy, on the other hand, is an outpatient procedure in the hospital that requires IV sedation.
What Is Screening For Prostate Cancer
Some men get a PSA test to screen for prostate cancer. Talk to your doctor, learn what is involved, and decide if a PSA test is right for you.
Cancer screeningexternal icon means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated, and to find them early before they spread.
If you are thinking about being screened, learn about the possible benefits and harms of screening, diagnosis, and treatment, and talk to your doctor about your personal risk factors.
There is no standard test to screen for prostate cancer. Two tests that are commonly used to screen for prostate cancer are described below.
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What To Do If You Are Worried About Prostate Cancer
Talk to your GP if you’re worried about prostate cancer. Or if you have urinary symptoms such as difficulty passing urine. The symptoms don’t mean that you have prostate cancer, but it is important to get them checked.
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Adult screening programme Prostate cancerUK National Screening Committee, Last accessed March 20222
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Screening for prostate cancer. External review against programme appraisal criteria for the UK National Screening CommitteeUK National Screening Committee, October 2020
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Prostate cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow upC Parker and others
What Tests Screen For Prostate Cancer
Two tests are commonly used to screen for prostate cancer:
- A prostate-specific antigen test, also called a PSA blood test. PSA is a protein made by your prostate. A high level of PSA in your blood may mean you have prostate cancer, but it’s not proof of cancer. That’s because many other things may cause high PSA levels, including:
- Having an enlarged prostate
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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.
There Are Risks To Getting Prostate Cancer Tests And Treatments
If your PSA is not normal, you will probably have a biopsy. The doctor puts a needle through the wall of the rectum and into the prostate to take a few samples. Biopsies can be painful and cause bleeding. Men can get serious infections from biopsies, and they may need hospital care.
Surgery or radiation are the usual treatments for prostate cancer. They can do more harm than good. Treatment can cause serious complications, such as heart attacks, blood clots in the legs or lungs, or even death. In addition, 40 men out of 1,000 will become impotent or incontinent from treatment.
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What Is The Controversy Surrounding Psa Screening
In recent years, there has been some controversy surrounding the PSA test. In 2012, the U.S. Preventive Services Task Force assigned the PSA test a D rating. This meant that the USPSTF concluded the harms that resulted from PSA testing, such as unnecessary biopsies and negative treatment side effects, outweighed the benefits of finding and managing the disease early. This recommendation did not include exceptions for men at increased risk of developing the disease, such as African American men, those with a family history of the disease, and those with BRCA gene mutations. The USPSTF recommendation is important as it guides primary care physicians in preventive care and can impact insurance coverage and reimbursement for screening. Prior to its D rating, the PSA test had an I rating, meaning the USPSTF concluded there was insufficient evidence to assess the pros and cons of testing.
In May 2018, the USPSTF updated their recommendation on PSA screening. In response to new research demonstrating the benefits of PSA screening , an increase in the number of men choosing active surveillance, and advocacy efforts, the USPSTF released a draft recommendation in April 2017 that assigns the PSA test a C rating for men ages 55 to 69 . This rating has now been certified official by the task force.
Research Into Prostate Cancer Screening
Research is ongoing to find other prostate cancer screening tests and ways to improve the current test. This includes:
- new blood and urine tests
- a combination of a blood test and other information such as age and family history
- MRI and other types of scans
More research is needed to find out whether these tests are reliable enough to detect prostate cancer.
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Screening For Prostate Cancer
There is no national screening programme for prostate cancer in the UK. This is because there isnt a reliable test that can pick up prostate cancer that needs treatment at an early stage.
Overall research has shown that current tests dont reduce the number of men dying from prostate cancer. Research is going on to find a new test. Or see if the current test is more effective if used in a different way and can find the cancers that need treatment more accurately.
Is Psa The Same As Psma
The PSA test is different from the PSMA PET scan.
The PSA test is a blood test that measures the level of PSA in your blood. PSA is a protein produced by cells in your prostate gland. High levels of PSA are often a sign of prostate cancer.
The PSMA PET scan is used after PSA testing if your doctor isnt sure if or where prostate cancer has spread. It can more accurately pinpoint where prostate cancer cells are located throughout the body.
Your doctor may order a PSA blood test to:
- screen for prostate cancer if you dont have symptoms of the disease
- determine whether further tests are necessary to diagnose prostate cancer if you do have symptoms of the disease
- check for signs that prostate cancer has come back if youve received successful treatment for the disease
PSA blood test results are not enough to diagnose prostate cancer or learn whether it has spread or returned. If you have high levels of PSA, your doctor will order other follow-up tests to develop an accurate diagnosis.
Your doctor will only order a PSMA PET scan if they think you may have prostate cancer that has spread beyond the prostate gland.
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The Prostatic Specific Antigen
In order for a prostate cancer screening test to be of health benefit it should be both highly specific and, highly sensitive for detecting ONLY potentially lethal prostate cancers. However, the PSA is neither specific and, is highly insensitive for detecting only significant prostate cancers.
Despite a standard FDA approval resting primarily on whether a device is safe and effective, the highly ineffective PSA and its 78 percent FALSE POSITIVE RATE was given an FDA approval in 1994. The high false positive rate is because the PSA leads to the detection of mainly benign and non-lethal prostate conditions and, commonly FAILS to lead to the detection of the 15 percent or so of important, potentially lethal high-grade prostate cancers.
When Is The Psma Pet Test Used
Your doctor might order a PSMA PET scan if youve recently received a new diagnosis of prostate cancer and they think it may have spread to other parts of your body. Or your doctor may use it to get a better idea of where prostate cancer has spread.
Prostate cancer is usually diagnosed in its early stages, before it has spread. However, some people are at heightened risk of metastatic prostate cancer.
Your doctor might order PSMA PET-CT at the time you are diagnosed with prostate cancer if you have any risk factors for metastatic disease, Dr. Michael Feuerstein, a urologist at Lenox Hill Hospital in New York City, tells Healthline.
According to Feuerstein, doctors use the following measurements to assess the risk of metastatic prostate cancer:
- Prostate-specific antigen . PSA is a protein made by the prostate thats found in the semen and blood. It tends to be elevated in people with prostate cancer. A PSA blood test is one of the first tests doctors order to diagnose prostate cancer. Youre considered at risk of metastatic prostate cancer if you have a PSA blood level of 20 or higher.
- Gleason grade. This system assigns a score to classify how many abnormal prostate cancer cells are found in a tissue biopsy. A Gleason grade of 7 or higher puts you at higher risk of metastatic prostate cancer.
Your doctor might also order the PSMA PET test if you still have detectable prostate cancer after undergoing surgery to treat it, says Feuerstein.
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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.
Should You Know Your Psa Level
Instead of a national screening programme, there is an informed choice programme, called prostate cancer risk management, for healthy men aged 50 or over who ask their GP about PSA testing. It aims to give men good information on the pros and cons of a PSA test.
If you’re aged 50 or over and decide to have your PSA levels tested after talking to a GP, they can arrange for it to be carried out free on the NHS.
If results show you have a raised level of PSA, the GP may suggest further tests.
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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.