When Should I Get Tested
Beginning at about age 45, all men should talk to their doctor about screening for prostate cancer. If you are Black or have a family history of prostate or other cancers, you may be at higher risk and should talk to your doctor beginning at age 40. Other risk factors include an increased age and a history of exposure to chemicals.
Routine prostate cancer screening starts with a PSA blood test and may include a rectal examboth are quick and simple.
A Prostate-Specific Antigen blood test measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men who have prostate cancer. The PSA level may also be elevated for other reasons. Learn more about the PSA test here.
A Digital Rectal Exam is a physical exam that is done when a doctor or nurse inserts a gloved, lubricated finger into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities.
Talk to your doctor about your risk for prostate cancer and when to begin screening. If you do not have a doctor, do not have insurance, or cannot afford a test, find out if free screenings are available in your area on our Free Testing Map. If you do not see a free screening in your area, check back in the fall. Many screenings occur in September, during Prostate Cancer Awareness Month.
Watch prostate cancer experts Dr. Lowentritt and Dr. Siegel in this video discuss screening and diagnosis:
What Happens During A Prostate Exam
You don’t need to do anything specific to prepare for a DRE. Your provider will walk you through the steps of a DRE, but ask them questions if any parts of the exam are not clear.
A DRE can be done while you are standing or lying down. Your position will depend on factors like the layout of the exam room and any health conditions you may have.
If you’re going to stand during a DRE:
How Do Men Feel About The Rectal Exam
I think most men are willing to do it, but some men are exceptionally opposed to it. They might be happy to hear that there are studies ongoing in the United Kingdom looking at using magnetic resonance imaging as a screening tool to be able to avoid doing a digital rectal exam in the future. There is a large African immigrant population in London with a higher incidence of prostate cancerthey didnt want to have the prostate exam because they had a lot of opposition to it. They were uncomfortable with it.
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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.
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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Why Should I Get Both Prostate Cancer Screenings
Both screenings provide valuable information about your health that can detect prostate cancer, even at an early stage. One result without the other may not provide enough indication of whether or not treatment is necessary.
There are many reasons why a mans prostate may be enlarged, and prostate cancer is only one. When paired with a PSA blood test, results can better indicate whether further testing is needed to determine a diagnosis.
American Cancer Society Recommendations For Prostate Cancer Early Detection
The American Cancer Society recommends that men have a chance to make an informed decision with their health care provider about whether to be screened for prostate cancer. The decision should be made after getting information about the uncertainties, risks, and potential benefits of prostate cancer screening. Men should not be screened unless they have received this information. The discussion about screening should take place at:
- Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.
- Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative diagnosed with prostate cancer at an early age .
- Age 40 for men at even higher risk .
After this discussion, men who want to be screened should get the prostate-specific antigen blood test. The digital rectal exam may also be done as a part of screening.
If, after this discussion, a man is unable to decide if testing is right for him, the screening decision can be made by the health care provider, who should take into account the mans general health preferences and values.
If no prostate cancer is found as a result of screening, the time between future screenings depends on the results of the PSA blood test:
- Men who choose to be tested who have a PSA of less than 2.5 ng/mL may only need to be retested every 2 years.
- Screening should be done yearly for men whose PSA level is 2.5 ng/mL or higher.
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Who Should Get A Psa Test
Not everyone should get a PSA test. Why? Because many in this country are treated for low-risk prostate cancer that is discovered through the PSA test, even when it is unlikely that the disease will ever cause symptoms or lead to death. And treatment is associated with significant side effects, including impotence and incontinence . You should discuss whether prostate cancer early detection is right for you with your personal primary care physician.
To avoid the risks of over-treatment, Roswell Park follows the guidelines established by the National Comprehensive Cancer Network . The NCCN brings together world-renowned experts from 30 of the nations top cancer centers to write guidelines that specify the best ways of preventing, detecting and treating cancer. The guidelines are updated at least every year, on the basis of the latest research.
Michael Kuettel, MD, PhD, MBA, Chair of Roswell Park’s Department of Radiation Medicine, serves on the NCCN Prostate Cancer Panel.
If you decide that Prostate Cancer Early Detection is right for you, the NCCN recommends PSA testing as follows:
Is It Time You Booked A Prostate Exam
Prostate checks are a part of life for most adult men. Its a necessary step to ensure that you stay on top of your health and become aware of any abnormalities before they evolve into serious problems.
For many men, it can be a nervous time. General Practitioner, Dr Sir-Kit Leong, from SmartClinics Clayfield in Brisbane has answered some of the most frequently asked questions by patients. Take a read and if youre still unsure, book an appointment with your GP for a chat before committing.
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If Screening Test Results Arent Normal
If you are screened for prostate cancer and your initial blood PSA level is higher than normal, it doesnt always mean that you have prostate cancer. Many men with higher than normal PSA levels do not have cancer. Still, further testing will be needed to help find out what is going on. Your doctor may advise one of these options:
- Waiting a while and having a second PSA test
- Getting another type of test to get a better idea of if you might have cancer
- Getting a prostate biopsy to find out if you have cancer
Its important to discuss your options, including their possible pros and cons, with your doctor to help you choose one you are comfortable with. Factors that might affect which option is best for you include:
- Your age and overall health
- The likelihood that you have prostate cancer
- Your own comfort level with waiting or getting further tests
If your initial PSA test was ordered by your primary care provider, you may be referred to a urologist for this discussion or for further testing.
Imaging Tests For Prostate Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. One or more imaging tests might be used:
- To look for cancer in the prostate
- To help the doctor see the prostate during certain procedures
- To look for spread of prostate cancer to other parts of the body
Which tests you might need will depend on the situation. For example, a prostate biopsy is typically done with transrectal ultrasound and/or MRI to help guide the biopsy. If you are found to have prostate cancer, you might need imaging tests of other parts of your body to look for possible cancer spread.
The imaging tests used most often to look for prostate cancer spread include:
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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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However, suppose you are at a higher risk of prostate cancer or are experiencing urinary or sexual symptoms. In that case, you should have a discussion with your healthcare provider about prostate cancer screening sooner rather than later. People who may have a high risk of prostate cancer include :
- African Americans
- Men with a family history of prostate cancer or who have tested positive for BRCA1, BRCA2, or HOXB13 gene mutations
- Men with symptoms like blood in the urine, painful or frequent urination, or sexual problemsthese may be signs of problems with the prostate, including prostate cancer.
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What To Expect From A Prostate Exam
This video, prepared by Gerald Chodak, MD, a Chicago-based urologist, is one of a series of independent, educational video materials about the prostate and prostate disorders for consumers and patients that are accessible on Dr. Chodaks ProstateVideos.com web site. This is a valuable resource for people who prefer audiovisual learning tools to text-based information.
Copyright to this video presentation is owned by ProstateVideos.com. We thank Dr. Chodak for permission to embed this video into The New Prostate Cancer InfoLink.
Content on this page last reviewed and updated, November 26, 2008
Special Types Of Psa Tests
The PSA level from a screening test is sometimes referred to as total PSA, because it includes the different forms of PSA . If you decide to get a PSA screening test and the result isnt normal, some doctors might consider using different types of PSA tests to help decide if you need a prostate biopsy, although not all doctors agree on how to use these tests. If your PSA test result isnt normal, ask your doctor to discuss your cancer risk and your need for further tests.
Percent-free PSA: PSA occurs in 2 major forms in the blood. One form is attached to blood proteins, while the other circulates free . The percent-free PSA is the ratio of how much PSA circulates free compared to the total PSA level. The percentage of free PSA is lower in men who have prostate cancer than in men who do not.
If your PSA test result is in the borderline range , the percent-free PSA might be used to help decide if you should have a prostate biopsy. A lower percent-free PSA means that your chance of having prostate cancer is higher and you should probably have a biopsy.
Many doctors recommend a prostate biopsy for men whose percent-free PSA is 10% or less, and advise that men consider a biopsy if it is between 10% and 25%. Using these cutoffs detects most cancers and helps some men avoid unnecessary biopsies. This test is widely used, but not all doctors agree that 25% is the best cutoff point to decide on a biopsy, and the cutoff may change depending on the overall PSA level.
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What If My Test Results Are Abnormal
If the results of early detection tests like the PSA screening or the digital rectal exam suggest that you might have prostate cancer, your doctor will conduct further testing. The PSA may be repeated, or you may be sent to a specialist for more tests such as a transrectal ultrasound and a prostate biopsy.
In a prostate biopsy, a tissue sample is taken from your prostate. Cancer can only be diagnosed with a tissue sample.
Recent research has yielded additional tests in addition to the PSA, DRE, and biopsy that can give a doctor more information to determine the probability of both finding cancer during a biopsy and determining how aggressive that cancer is likely to be. Read more on those tests.
The Risks Of Prostate Screening Include The Following:
Finding prostate cancer may not improve health or help a man live longer.
Screening may not improve your health or help you live longer if you have cancer that has already spread to the area outside of the prostate or to other places in your body.
Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. Finding these cancers is called overdiagnosis. It is not known if treatment of these cancers would help you live longer than if no treatment were given.
Treatments for prostate cancer, such as radical prostatectomy and radiation therapy, may have long-term side effects in many men. The most common side effects are erectile dysfunction and urinary incontinence.
Some studies of patients with newly diagnosed prostate cancer showed these patients had a higher risk of death from cardiovascular disease or suicide. The risk was greatest in the first weeks or months after diagnosis.
Follow-up tests, such as a biopsy, may be done to diagnose cancer.
If a PSA test is higher than normal, a biopsy of the prostate may be done. Complications from a biopsy of the prostate may include fever, pain, blood in the urine or , and urinary tractinfection. Even if a biopsy shows that a patient does not have prostate cancer, he may worry more about developing prostate cancer in the future.
False-negative test results can occur.
False-positive test results can occur.
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What Should I Expect During A Prostate Exam
As mentioned above, there are two types of screenings that your healthcare provider may use to detect prostate cancer: a PSA blood test and a digital rectal exam . Research shows that the PSA blood test is more effective for detecting prostate cancer. However, the DRE can still find cancer in people with normal PSA levels. For this reason, many healthcare providers recommend both.
Neither test confirms you have prostate cancer, which is why theyre considered screening assessments rather than diagnostic tests.
PSA blood test
For this test, your healthcare provider simply draws a sample of your blood and sends it to a lab for analysis. The PSA blood test measures the amount of prostate-specific antigen in your blood.
There is no official cutoff score that can determine whether or not you have prostate cancer. Instead, the results are used as a gauge to determine if more testing is needed.
If you have a high PSA, you may need further testing such as a prostate biopsy, MRI or other lab tests to determine if prostate cancer may be present.
Digital rectal exam
During a DRE, your healthcare provider inserts a lubricated, gloved finger into your rectum. This way, they can feel your prostate to see if there are any lumps or bumps on the back portion of the gland .