1 in 8 men will experience prostate cancer in their lifetime

Thanks to advances in early diagnoses and prostate cancer treatments, patients nearly always have an excellent prognosis if their cancer is caught early. Because prostate cancer is rarely symptomatic, most patients are diagnosed after a prostate cancer screening blood test (PSA test).

The American Cancer Society recommends different screening ages depending on individual prostate cancer risk. For example, men at average risk of developing prostate cancer should begin screening at age 50. Men at high risk (African Americans and men who have a first-degree relative diagnosed with prostate cancer at an early age) should begin screening at age 45. For men at even higher risk (those with more than one first-degree relative diagnosed with prostate cancer at an early age), they should begin screening at age 40.

Should I get screened for prostate cancer?

Prostate cancer screening is somewhat controversial. In 2018, the US Preventative Services Task-Force (USPSTF) gave PSA screening a grade “C” and suggested that screening should be pursued only after a discussion with a provider about risks and benefits.

While the physical risks of the PSA blood test are minimal, screening can cause stress if the patient has an elevated PSA or if additional testing is required, which can be more invasive and costly. A diagnosis of low-grade prostate cancer often does not require radical therapy, but it may also exacerbate anxiety and require further testing.

Discussing your concerns regarding PSA testing with your primary care physician is an important first step in deciding whether you would benefit from screening.  There are reasons why some men may choose to forego prostate cancer screening after having a discussion with their provider. Some reasons for this include:

• Significant health problems or older age (both of which limit life expectancy), as many prostate cancers are slow growing and non-aggressive
• An unwillingness or strong desire to avoid further testing for prostate cancer or potential treatment should a prostate cancer be diagnosed

Ultimately, the decision to be screened for prostate cancer is one that you and your primary care physician should make together based on your general health, level of risk, and thoughts on screening and further prostate cancer testing.

Contact your primary care physician

Whether you are experiencing symptoms or simply want to comply with ACS screening guidelines, you should first contact your primary care physician. If it is determined that you should be screened, your provider will either perform the screening in office or refer you to a urologist.

Prostate cancer screening options

There are two options when it comes to prostate cancer screening tests: the PSA test and the DRE.

The prostate-specific antigen (PSA) test: a blood test that measures the level of PSA, a substance produced by the prostate. Its levels may be elevated in the blood of men who have prostate cancer. PSA levels may also be high in men who have an infection or inflammation of the prostate.

The PSA test is the primary screening method for prostate cancer. Siteman physicians pioneered this test

The digital rectal exam (DRE): an exam during which the doctor or nurse inserts a gloved, lubricated finger into the rectum to check for lumps, hard spots or an enlarged prostate. Men are positioned either lying on their side with their knees drawn toward their chest or standing while bent at the waist. Although this method of screening can be uncomfortable, it usually isn’t painful (unless the patient has hemorrhoids or anal fissures) and only takes 1-2 minutes.

Additional prostate cancer tests:

For men with an elevated PSA, the standard recommendation was previously to perform a prostate biopsy. Biopsy is a moderately invasive procedure with occasional complications and side effects. Over the last 20 years, however, researchers have developed new strategies to further inform your risk of prostate cancer. These include additional blood tests (such as the 4K score or PHI test), MRI imaging of the prostate, genetic testing, urinary biomarkers, and micro-ultrasound examinations of the prostate. These tests are routinely utilized by Siteman providers to further inform men of their prostate cancer risk and to help men with elevated PSA decide whether a biopsy might be right for them.

Now that you know

Actively engaging in discussions with your provider about your prostate health and being proactive about getting screened can give you reassurance that you’re in good health, or the peace of mind of knowing that any problems have been caught in their early stages.

If you have received a prostate cancer diagnosis, rest assured that the Washington University Physicians at Siteman will make your health a top priority and create an entirely individualized treatment plan for you, managed by a multidisciplinary team. Based on your case, this plan may involve active surveillance, focal therapy, systemic therapy, radiation therapy, or surgery.

The long-term prognosis for prostate cancer is quite promising. Average survival rates represent a patient’s chance of survival after a certain number of years compared to the larger population’s chances of survival during the same timeframe. Prostate cancer survival rates (including all stages of cancer) are as follows:

• 5-year relative survival rate: nearly 100%
• 10-year relative survival rate: 98%
• 15-year relative survival rate: 95%

Click here for more key statistics for prostate cancer.