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When should men be tested for prostate cancer?

Dr. Jesse N. Mills, MD
Urologist

When you reach your 40s, you need to be a little smarter and a little more individualized in your healthcare response. Family history of disease starts to come into play at this age. If you have a first degree relative with prostate cancer—a father, brother or uncle—you should get screened about 10 years earlier than what is recommended. This is especially important if your family member was diagnosed with early prostate cancer. Otherwise, we recommend prostate cancer screening in men to start around age 55.

African American men have a higher risk of prostate cancer. If you are African American, doctors also recommend prostate cancer screening starting in your 40s.

Men in their 40s may be screened for prostate cancer when they are at high risk.

African American men and men who have a first-degree relative (father, brother or son) diagnosed with prostate cancer at an early age (younger than age 65) should discuss the uncertainties, risks and potential benefits of prostate cancer screening with a doctor, starting at age 45.

This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age). After this discussion, those men who want to be screened should be tested with the prostate specific antigen (PSA) blood test. The digital rectal exam (DRE) may also be done as a part of screening.

Dr. Mark S. Litwin, MD
Urologist

If you have decided to be screened for prostate cancer, the general advice is that if you're in a high-risk group, you should be screened once a year. There's also evidence that every-other-year screening may be appropriate if your prostate-specific antigen (PSA) level is low normal. However, most experts say that if you're going to be screened, annually is the right interval.

You should get a baseline rectal exam and PSA blood test at age 40. Then, get a PSA and rectal exam every 2 years until age 50, and then annually. This is particularly important in African American men or those men with a first degree relative with prostate cancer. PSA screening can end once your life expectancy is considered to be less than 10 years, from other medical problems.

Physicians don't know when prostate cancer starts. It's assumed that the cancer starts in the 20s or 30s and grows, says William Oh, MD, an oncologist at The Mount Sinai Medical Center. In this video, he discusses when prostate cancer may begin.

You should discuss prostate cancer screening with your doctor. If early detection through screening does improve health outcomes, those most likely to benefit are:

  • men ages 50 to 70 who are at average risk for prostate cancer
  • men older than 40 years old who are at greater risk, which includes African-American men and men with a family history of prostate cancer
Dr. Ajay K. Sahajpal, MD
Transplant Surgeon

There is no standard screening protocol for screening for prostate cancer. Studies are underway to evaluate. Typically a yearly digital rectal exam by an experienced MD along with a blood test, called a prostate specific antigen, which may be used as a tumor marker for prostate cancer (may be elevated for other benign conditions) are considered screening tests. A combination of these two are reasonable to begin after the age of 50.

Recent data suggests that there is no apparent reduction in all-cause mortality related to a rigorous PSA screening strategy and in fact there may be greater morbidity or side effects from the screening process and resultant testing. As such, it may be most beneficial to focus on a healthy, well balanced lifestyle with diet and exercise and regular medical examination. Further testing may be triggered only when symptomatic.

The U.S. Preventive Services Task Force recommends that men 55 to 69 may be screened for prostate specific antigens, a simple blood test that can indicate the possible presence of cancer in the prostate. Many doctors will recommend this as part of a regular physical exam for men. A digital rectal exam can be performed as well to feel for any abnormalities in the prostate. The American Cancer Society recommends screening for: men 50 and older who are expected to live 10 or more years; men 45 and older who are at high risk (African Americans, men who have had a close relative with prostate cancer under age 65); and men 40 and older who are at very high risk (those who had a first-degree relative with prostate cancer at an even younger age). It is up to the patient to decide to have the screening. If the PSA exam comes back lower than 2.5 ng/mL, the patient may be fine to wait two years for another check. If it is 2.5 ng/mL or over but there is no sign of cancer, another check should be done the next year. The USPSTF does not recommend screening for men 70 and older.

It is recommended that all men be tested for prostate cancer at the age of 50. For African American men, or men with a family history of prostate cancer, screening is recommended as early as 40.

The American Cancer Society recommends that men make an informed decision with their doctor about whether to be tested for prostate cancer, beginning at age 50. Men with one or more risk factors for prostate cancer should consult with their physician about whether to start routine screening earlier.
Dr. Tyler S. Carroll, MD
Family Practitioner

Prostate cancer screening is highly controversial. Most physician groups recommend men discuss with their physician the pros and cons of prostate cancer screening and make a decision they are comfortable with. This discussion should be had around the age of 50. If you have a family history of prostate cancer there are stronger arguments for screening.

Prostate cancer screening has not proven to improve overall survival in men and can lead to invasive and expensive procedures that may otherwise be avoided. Conversely, screening may lead to a cancer being found that may spread. 

Prostate cancer is usually a slow growing cancer that remains in the prostate. When prostate cancer is found, we are unable to tell if it will remain in the prostate or spread. 

Also, the available screening tests for prostate cancer are not very specific or sensitive. PSA testing is difficult as cancer may be present at any level and high PSAs may be found in benign enlarging prostates. Digital prostate exams have poor sensitivity and variable physician interpretation. 

If you decide to screen, the best method is probably a digital rectal exam and PSA blood test yearly starting at age 50. Possibly sooner if you have a strong family history.

 

Men should have PSA screening and prostate exam at age 40.

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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.