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Prostate cancer screening for men: Should you get a PSA test?

For men, the decision to get a prostate cancer screening is personal and complex. Medical organizations offer different recommendations regarding prostate cancer screenings. And, unlike other types of cancer, not all prostate cancers need treatment. Some men may find that the potential risks of screenings outweigh the benefits. Only you and your doctor can decide whether or not prostate cancer screening is right for you.


What does the prostate do?

The prostate gland is part of the male reproductive system. It sits deep inside the groin, just below the bladder and in front of the rectum. In younger men, the gland is about the size of a walnut, but it can grow as you age. The main purpose of the prostate is to produce fluid that nourishes and transports sperm.


How common is prostate cancer?

Apart from skin cancer, prostate cancer is the most common cancer in American men and the second most common type of cancer in men worldwide. Prostate cancer often grows slowly and may not spread beyond the prostate gland or cause serious health risks. However, aggressive types of prostate cancer can spread quickly and cause serious health problems. When prostate cancer is detected early, treatment has a better chance of being successful.


What are the symptoms of prostate cancer?

In its early stages, prostate cancer may have no signs or symptoms. In later stages of the disease, prostate cancer symptoms may include:

  • Frequent urination
  • Weak or interrupted urine flow
  • Having to strain to empty the bladder
  • The urge to urinate frequently at night
  • Blood in the urine
  • Blood in the semen
  • Erectile dysfunction

Experiencing any of these symptoms doesn’t mean you have prostate cancer. If you’re worried about a particular sign or symptom, talk to your doctor.


What are the risk factors of prostate cancer?

It’s not clear what causes the disease, but experts have identified a number of risk factors for prostate cancer:

Age. The chances of developing prostate cancer increase as you grow older.

Race/ethnicity. For reasons that are not yet clear, African American men have a greater risk of developing prostate cancer than men of other races.

Geography. Prostate cancer is more common in North America, northwestern Europe, Australia, and the Caribbean.

Family history. If a man in your family has prostate cancer—especially your father, brother, or son—you have an increased risk of developing the disease.

Gene changes. In a small percentage of cases, inherited mutations of the BRCA1 or BRCA2 genes—the so-called breast cancer genes—can increase the risk of prostate cancer in men.


How is prostate cancer diagnosed?

Doctors use a simple blood test called the prostate-specific antigen (PSA) test to screen for prostate cancer. The test measures the level of PSA, a protein made by the prostate gland, in the blood.

PSA levels tend to be higher in men who have prostate cancer. However, many other factors can affect PSA levels, including:

  • Medical procedures
  • Medications
  • An enlarged prostate
  • A prostate infection

While the PSA number is important, your doctor will consider a number of other factors when evaluating your test results, including your age, the size of your prostate gland, and how quickly your PSA levels are changing.

The goal of a prostate cancer screening is to find cancer early, before it causes any symptoms and before it has a chance to spread. Treatment is most effective when cancer is identified early.

If your PSA test is abnormal, your doctor may recommend a biopsy to find out if you have prostate cancer.


What are the pros and cons of the PSA test?

Before you decide to get a PSA test, talk to your doctor about whether prostate cancer screening is right for you. Discuss your risk factors, overall health, and life expectancy. And, consider the pros and cons of the PSA test:

Pros:
  • PSA screening may help detect prostate cancer early, when it’s easier to treat and more likely to be cured.
  • The test is widely available and involves little risk. It requires simply drawing blood for evaluation in a lab.
  • Fewer men have died from prostate cancer since PSA testing became available.

Cons:
  • PSA tests aren’t perfect. A test may show high levels of PSA when cancer isn’t present (false-positives) or low levels of PSA when cancer is present (false-negatives).
  • Not all prostate cancers need treatment. Some prostate cancers grow slowly and never spread beyond the prostate gland. Very few men with non-aggressive or low-risk prostate cancer will die in the first decade after diagnosis. In these cases, a patient may be better off leaving the cancer untreated. However, living with a slow-growing cancer that doesn’t need treatment may cause stress.
  • Treatment for prostate cancer may have side effects, including urinary incontinence, erectile dysfunction, or bowel dysfunction.

When should you ask your doctor about getting a PSA test?

The American Cancer Society recommends that men should start discussing prostate cancer screenings with their doctors at different ages, depending on individual risk factors:

  • Age 50 for men who are at average risk of prostate cancer and expect 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 father, brother, or son diagnosed with prostate cancer when they were younger than age 65.
  • Age 40 for men at even higher risk, including those with more than one father, brother, or son who had prostate cancer before age 65.

Prostate cancer often grows slowly, so men without symptoms of prostate cancer who do not expect to live at least 10 years are unlikely to benefit from screening. The U.S. Preventive Services Task Force (USPSTF) prostate cancer screening guidelines recommend that men ages 55 to 69 should discuss the potential benefits and risks of prostate cancer screening with their doctors. Men age 70 and older—and men with a serious medical condition that limits their life expectancy—should not be screened.


Can prostate cancer be prevented?

While studies have yet to prove that you can prevent cancer through diet and exercise, healthy eating and physical activity can improve your overall health:

Eat a healthy diet. Fill your plate with fruits, vegetables, whole grains, and foods that are rich in vitamins and minerals. Avoid high-fat foods.

Exercise. Physical activity can help you maintain a healthy weight and boost your mood. Of course, check with your doctor before starting a new exercise program.

Maintain a healthy weight. If you need to lose weight, move more, sit less, and try to reduce the number of calories you eat each day. Ask your doctor to help you create healthy weight loss plan.


What if you still have questions about prostate cancer screenings?

Talk to your doctor about any questions or concerns you have about prostate cancer screenings. Together, you can decide what’s right for you.