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Patient education: Prostate cancer screening (PSA tests) (The Basics)
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Patient education: Prostate cancer screening (PSA tests) (The Basics)
Written by the doctors and editors at UpToDate
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Nov 2017. | This topic last updated: Mar 24, 2017.

What is prostate cancer screening? — Prostate cancer screening is a way in which doctors check the prostate gland for signs of cancer. In men, this gland sits below the bladder and in front of the rectum. It forms a ring around the urethra, the tube that carries urine out of the body (figure 1). (Women do not have a prostate gland.)

The main test used to screen for prostate cancer is a blood test called a "PSA test." Some men also have an exam called a rectal exam (figure 2).

Who should be screened for prostate cancer? — Prostate cancer screening is done in men who have no symptoms of the disease. It is not clear whether getting screened for prostate cancer can extend a man's life or help him avoid any symptoms or problems. For this reason, doctors do not know who – if anyone – should be screened for prostate cancer.

Most experts recommend that each man work with his doctor or nurse to decide whether screening is right for him. In most cases, men should start discussing prostate cancer screening around the age of 50. Men with risk factors for prostate cancer (such as black men or men with a family history of prostate cancer) might want to begin screening at age 40 to 45. Most doctors recommend against screening for men age 70 or older, or for men with serious health problems.

Why do doctors offer screening? — Doctors offer screening in the hopes of catching prostate cancer early – before it has a chance to grow, spread, or cause symptoms. With many cancers, catching the disease early is an important part of effective treatment. But prostate cancer is not like many other cancers. It usually grows slowly and does not usually lead to death. The problem is that a small number of prostate cancers are serious and can lead to death. Doctors do not have an ideal way to tell which prostate cancers are deadly and which ones would never cause any problems. Certain tests can suggest which prostate cancers might be more likely to cause problems. But the tests are far from perfect.

To make matters more confusing, different studies draw different conclusions about the benefits of prostate cancer screening. One big study found that screening lowers the risk of dying from prostate cancer. Another big study found that it does not.

What are the drawbacks to getting screened? — PSA tests have 2 main drawbacks:

PSA tests sometimes give "false positives," meaning they indicate cancer when there is no cancer. This can lead to unneeded worry and to further tests – including one test (a biopsy) that can be briefly painful.

When PSA tests lead to the discovery of cancer, there is very often no way to tell whether the cancer is one that could do harm. That means that men sometimes get treated for cancers that would not have done them any harm. That's a problem because treatment for prostate cancer has risks and often causes problems of its own. For instance, prostate cancer treatment can cause men to leak urine and to have problems with sex.

How do I decide if I should be screened? — Work with your doctor or nurse to decide if screening is right for you. As you are deciding, think about how likely it is that you will get prostate cancer. Black men and men who have a brother or father with the disease are more likely than other men to get it. For men with a high risk of prostate cancer, screening might be a good idea.

Think, too, about how you feel about the possible benefits and harms of being screened. Ask yourself:

Do I want to know if I have prostate cancer, even if the cancer might never do me any harm?

Would I be treated if I learned that I had prostate cancer?

How do I feel about the risks of being treated for prostate cancer?

How do I feel about the risks of getting a deadly or aggressive form of prostate cancer?

Would I be willing to accept a high risk of side effects from treatment in return for a small chance of living longer?

What is a PSA test? — PSA stands for "prostate-specific antigen." PSA is a protein made by the prostate. Levels of this protein usually go up when a man has prostate cancer. The protein also goes up for reasons that do not involve cancer. For example, PSA levels rise when a man:

Has a condition called benign prostatic hyperplasia (BPH), sometimes called an enlarged prostate

Has a prostate infection, also called prostatitis

Hurts his prostate, for example while riding a bike

Ejaculates (has an orgasm)

What if my PSA level is too high? — If your PSA level is high, do not panic. It's possible your PSA is high for reasons unrelated to cancer. If your PSA level is only somewhat high, often the next step is to have the PSA test again. For 2 days before the second test, avoid ejaculating and bike-riding. If your doctor thinks you have a prostate infection, you might also need to take antibiotics for a while before you repeat the test.

If your PSA is still high on the second test, or if it was very high the first time, you will probably need a biopsy. That means that a doctor will insert a needle into your prostate to take tiny samples of tissue. Those samples will then go to the lab to be checked for cancer.

If it turns out you do have cancer, remember that prostate cancer is not usually deadly. It usually grows slowly, so you probably have time to decide what to do. There are treatments that can sometimes cure prostate cancer. But men sometimes hold off on having treatment and wait to see if their cancer shows signs of progressing.

How often should a man be screened for prostate cancer? — For those who decide to be screened, experts recommend repeating screening every 2 to 4 years.

Men can stop being screened when they turn 70 or if they develop serious health problems. In these cases, the benefits of screening are not worth the possible harms.

More on this topic

Patient education: Cancer screening (The Basics)
Patient education: Prostate cancer (The Basics)
Patient education: Choosing treatment for low-risk localized prostate cancer (The Basics)
Patient education: Benign prostatic hyperplasia (enlarged prostate) (The Basics)

Patient education: Prostate cancer screening (Beyond the Basics)
Patient education: Treatment for advanced prostate cancer (Beyond the Basics)
Patient education: Prostate cancer treatment; stage I to III cancer (Beyond the Basics)
Patient education: Benign prostatic hyperplasia (BPH) (Beyond the Basics)

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