After skin cancer, prostate cancer is the second most common cancer in men in the United States. The prostate is part of the male reproductive system. It is a walnut-sized gland located around the urethra that produces seminal fluid.

Though prostate cancer begins in the prostate, it can spread to other parts of the body if not treated. Some men may decide to be screened for prostate cancer with the goal of detecting it early to treat it before it can spread. The decision of whether to be screened for prostate cancer is complex, and one that a man should make after having a discussion with a trusted health care provider.

How is prostate cancer screening done?

The two most common tests used to screen for prostate cancer are the prostate specific antigen (PSA) test and digital rectal examination (DRE).

PSA is a substance that is produced by the prostate, and PSA levels can increase in men who have prostate cancer. Therefore, a provider may choose to measure the level of PSA in a man’s blood as a way to screen him for prostate cancer. However, PSA levels can be affected by other medical conditions, procedures, and medications. Therefore, an elevated PSA level may not be an indication of prostate cancer, so it is important to have a health care professional who is familiar with the patient’s medical history interpret the results.

For DRE, the provider inserts a gloved finger into the patient’s rectum to feel if there are any abnormalities in the prostate. Currently, DRE is not recommended as a sole screening test for prostate cancer due to a lack of evidence on its effectiveness, but it may be done in combination with a PSA test.

What are the benefits of prostate cancer screening?

The main benefit of prostate cancer screening is that it may help a patient find the cancer at an early stage and treat it before it starts showing symptoms or can spread to other parts of the body. Since PSA testing has become available, the number of deaths caused by prostate cancer has decreased. Additionally, PSA testing is a minimally invasive procedure that is widely available.

What are the potential risks of prostate cancer screening?

Unfortunately, there is a possible downside to prostate cancer screening. Because PSA levels can increase for reasons other than prostate cancer, it is possible to get a “false positive” with a PSA test. False positive test results may cause further unnecessary steps such a prostate biopsy, which is more invasive than the initial screening and can lead to complications.

Prostate cancer screening can also lead to an overdiagnosis and treatment of the condition. Some men with prostate cancer may never experience symptoms or die from the disease, but a diagnosis of prostate cancer could lead to radiation therapy and/or prostatectomy. These treatments can have negative side effects for men like erectile dysfunction (ED) and urinary incontinence. 

Who should be screened for prostate cancer?

At this time, the U.S. Preventive Services Task Force recommends that men between the ages of 55 to 69 years old make personal decisions about whether to be screened for prostate cancer, with the counsel of their health care providers. They do not recommend prostate cancer screening to men who are 70 years old or older.

References:

• Centers for Disease Control and Prevention (CDC). (2022, August 25). Should I Get Screened for Prostate Cancer? https://www.cdc.gov/cancer/prostate/basic_info/get-screened.htm
  
  
• Ilic, D., Djulbegovic, M., Jung, J.H., Hwang, E.C., Zhou, Q., Cleves, A., Agoritsas, T., & Dahm, P. (2018). Prostate cancer screening with prostate-specific antigen (PSA) test: a systematic review and meta-analysis. BMJ, 362. DOI: https://doi.org/10.1136/bmj.k3519