What are the prostate cancer screening recommendations?

If tests have indicated the possibility of prostate cancer, you can prepare a list of questions for your doctor. You should have an idea of what other tests you'll be subject to, and you should feel free to ask about the circumstances the test or tests will be carried out. In particular, ask if there's anything you need to do to prepare, how long it will take to recover from the test, and how soon you'll know the results. You should also prepare lists for the doctor's reference: symptoms you've been feeling, if any; a list of medications and vitamins you're currently taking; and key personal information such as recent major sources of stress in your life. Lastly, take along a friend or family member for support and to help remember questions you may forget.

Digital rectal examination, measurement of serum tumor markers and transrectal ultrasound scanning are used to screen for prostate cancer. The accuracy of test results is confirmed if microscopic examination of tissue obtained by biopsy or surgery indicates malignant disease in the samples.

Digital rectal examination: Although gloved-finger examination of the rectum is the oldest screening test for prostate cancer, its effectiveness is limited. The examiner can feel only certain areas of the prostate, and 25-35 percent of tumors occur in areas not accessible to the examiner. Furthermore, early tumors are too small to be felt. This test is ineffective and not recommended for prostate cancer screening, though it may prove useful in addition to prostate-specific antigen (PSA) testing, particularly in high risk populations.

Measurement of serum tumor markers: Tumor markers are substances (PSA and prostatic acid phosphatase) in the blood that often are higher than normal when a person has cancer. This increase provides another way to screen for prostate cancer. However, some common non-cancerous prostate conditions (prostatitis or benign hypertrophy) also can cause higher blood levels, and this can produce a false-positive result. That is, the test would indicate an abnormality that did not really exist. For example, about 25 percent of men with enlarged prostates but no malignancy have elevated levels of PSA.

Transrectal ultrasound scanning: This test uses the reflection of sound waves in the body to create a picture. It is usually performed after discovery of a nodule by digital rectal examination. The test has limited usefulness, however, as a way to screen for prostate cancer. It cannot distinguish benign nodules from malignant nodules. And even when cancers are detected, the size of the tumor often is underestimated.

While screening recommendations are still under review, since the ill effects of false positives can be life altering, and cancers of the prostate tend to grow slowly, it is recommended that doctors and patients ages 55-69 discuss the benefits and possible harms of PSA testing, so patients can understand and participate in the decision to undergo screening. Generally, men 70 and older should not be screened.

Prostate cancer screening is crucial to catching the disease in a timely manner. In this video, Winston Wilfong, MD, of Coliseum Medical Centers, explains the importance of screening and who should have it done.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.