Prostate cancer screening

Prostate-specific antigen (PSA) test is a blood test that checks the level of PSA in your blood.

• In some cases, a high level of PSA could mean you have prostate cancer.
• But other conditions can also cause a high level, such as infection in the prostate or an enlarged prostate. You may need another test to find out if you have cancer.
• Other blood tests or a prostate biopsy can help diagnose a cancer if the PSA test is high.

Digital rectal exam (DRE) is a test in which your provider inserts a lubricated, gloved finger into your rectum. This allows the provider to check the prostate for lumps or unusual areas. Most cancers cannot be felt with this type of exam, at least in the early stages.

In most cases, the first step of prostate cancer screening is the PSA test but not a DRE because the added value of DRE for screening is very small.

The benefit of any cancer screening test is to find cancer early, when it is easier to treat. But the value of PSA screening for prostate cancer is debated. No single answer fits all men.

Prostate cancer often grows very slowly. PSA levels can begin to rise years before a cancer causes any symptoms or problems. It is also very common as men age. In many cases, the cancer will not cause any problems or shorten a man's life span.

For these reasons, it is not clear if the benefits of routine screenings outweigh the risks or side effects of being treated for prostate cancer once it is found.

There are other factors to think about before having a PSA test:

• Anxiety. Elevated PSA levels does not always mean you have cancer. These results and the need for further testing can cause a lot of fear and anxiety, even if you do not have prostate cancer.
• Side effects from further testing. If your PSA test is higher than normal, you may need to have one or more biopsies to find out for sure. A biopsy is safe, but can cause problems such as an infection, pain, fever, or blood in the semen or urine.
• Overtreatment. Many prostate cancers will not affect your normal life span. But since it is impossible to know for sure, most people want to get treatment. Cancer treatment can have serious side effects, including problems with erections and urinating. These side effects can cause more problems than the untreated cancer.

Measuring the PSA level can increase the chance of finding prostate cancer when it is very early. But there is debate over the value of the PSA test for detecting prostate cancer. No single answer fits all men.

If you're 55 through 69 years old, before having the test, talk to your provider about the pros and cons of having a PSA test. Ask about:

• Whether screening decreases your chance of dying from prostate cancer.
• Whether there is any harm from prostate cancer screening, such as side effects from testing or overtreatment of cancer when discovered.
• Whether you have a higher risk for prostate cancer than others.

If you are age 55 or younger, screening is not generally recommended. You should talk with your provider if you have a higher risk for prostate cancer. Risk factors include:

• Having a family history of prostate cancer (especially a brother or father)
• Being African American

For men older than age 70, most recommendations are against screening.

Prostate cancer screening - PSA; Prostate cancer screening - digital rectal exam; Prostate cancer screening - DRE

Carter HB. American Urological Association (AUA) guideline on prostate cancer detection: process and rationale. BJU Int. 2013;112(5):543-547. PMID: 23924423 pubmed.ncbi.nlm.nih.gov/23924423/.

National Cancer Institute website. Prostate cancer screening (PDQ) - health professional version. www.cancer.gov/types/prostate/hp/prostate-screening-pdq#section/all. Updated February 18, 2022. Accessed October 28, 2022.

Nelson WG, Antonarakis ES, Carter HB, DeMarzo AM, DeWeese TL. Prostate cancer. In: Niederhuber JE, Armitage JO, Kastan MB, Doroshow JH, Tepper JE, eds. Abeloff's Clinical Oncology. 6th ed. Philadelphia, PA: Elsevier; 2020:chap 81.

US Preventive Services Task Force, Grossman DC, Curry SJ, et al. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA. 2018;319(18):1901-1913. PMID: 29801017 pubmed.ncbi.nlm.nih.gov/29801017/.

Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.