Establishing a routine schedule for prostate cancer screening is the best way to detect prostate cancer in its earliest stages–giving you the greatest chance of successful treatment.
When should you start screening?
First, talk to your doctor at your next checkup to go over your particular risk factors. You may have more than one risk factor at play and thus have a greater chance of developing prostate cancer than other men.
In general, screening for prostate cancer should begin in your 40s or 50s. Here are some rough guidelines:
|Do you have family history of prostate,
ovarian, breast, colon, or pancreatic cancers,
or do you know that Lynch syndrome,
BRCA, or HER2 mutations are present in your family?
|Consider screening starting in your early 40s|
|Do you have African ancestry?||Consider screening starting at around
|How old are you?||In the absence of other risk factors,
consider screening starting at around
|Where do you live?
Men in northern latitudes have higher risk.
|Consider screening a few (3-5) years
sooner than you otherwise would.
Learn more about how your age, race, and other factor may affect your prostate cancer risk.
How do I get screened?
Routine screening usually includes two simple tests: the PSA and the DRE.
The PSA test measures levels of prostate-specific antigen in the blood. It’s usually an add-on to other routine blood tests at a checkup. PSA is a protein produced by the cells of the prostate, and cancerous cells tend to produce more of it, so a spike in your PSA level can signify a problem—although there are other reasons why the levels might fluctuate. Tracking your PSA over time is a very valuable metric, because many cases of prostate cancer are very slow-growing. If your level is still within normal range, but is higher than it was the last time it was checked, it’s worth checking further.
PSA screening may reveal results that prompt a doctor to recommend a biopsy. However, the result may create more confusion when the PSA is only mildly elevated. Fortunately, there are many other supplementary tests and considerations that can help a man who is undergoing screening decide if a biopsy is necessary, including:
- The percent free PSA test (Less than 25% increases risk of having cancer)
- PSA velocity or the rate of rise over time (faster increases risk of having cancer)
- PSA density = PSA per volume of prostate (higher density increases risk of having cancer)
- Digital rectal exam results
- Different forms of PSA (e.g. pro-PSA)
- Measuring other urine (MiPS) and blood tests (4K panel)
The other routine test is the DRE, or digital rectal exam. For this test, your doctor will insert a gloved, lubricated finger into your rectum and press toward the front of your body to feel the prostate. A prostate that’s enlarged or irregularly shaped, or bigger than it was at your previous test, is a red flag that should be investigated.
Are there any other tests I should have as part of my screening routine?
Better cancer specific blood- and urine-based tests are on the horizon, as well as investigations into using imaging, such as MRI, to help screen and target the biopsy for prostate cancer. Regardless, the PSA test remains an important tool in the diagnostic process.
All PSA tests are not created equal!
It should be noted that these recommendations apply to screening only—that is, testing of healthy men without symptoms. Once the diagnosis of prostate cancer is confirmed by biopsy, PSA is still routinely recommended and used for risk-assessment and post-treatment monitoring.
What happens next?
If your PSA and/or your DRE results suggest that you might have prostate cancer, your doctor will order more tests, such as a biopsy, ultrasound, or MRI.
Learn more about how prostate cancer is diagnosed.
How is Prostate Cancer Diagnosed?
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