Many men feel uncomfortable at the mere mention of prostate screening. With all the misconceptions out there, it's tempting to avoid the topic altogether. An ongoing conversation with your primary doctor is important so that together, you can make informed decisions about your prostate health. Prostate cancer is a common cancer in men, and when detected early, more treatment options become available.

Prostate cancer is the second most common cancer in men

One in nine men will be diagnosed with prostate cancer in their lifetime. Statistically, 1 in 6 African American men and 1 in 5 men with a family history of prostate cancer will be diagnosed. Approximately 192,000 men were diagnosed with prostate cancer in 2020. Due to proper screening, nearly 3 million men in the U.S. are prostate cancer survivors.

Who should be screened and when

A variety of factors determine when and who should be screened. "Prostate screening is considered for men ages 55 to 69 but can be continued above age 70 in healthy men. Screening for prostate cancer may be considered for men between the ages of 40 and 54 in those at higher risk for cancer (African American, family history of prostate cancer)," says Dr. Christiansen. "Men outside the age range of 55 to 69 may still need to undergo prostate-specific antigen (PSA) blood testing or a prostate exam to assist with the diagnosis and management of benign prostatic hyperplasia (BPH) or other urologic conditions." 
 
The American Urologic Association (AUA) guidelines do not recommend routine screening in men between ages 40 to 54 years who are at average risk. For men younger than age 55 at higher risk, prostate cancer screening decisions should be individualized. A routine screening interval of two years or more may be preferred over annual screening in those men who have participated in shared decision making with their doctor.

Prostate screening methods

We encourage men not to put off screening out of fear. Today, a simple prostate-specific antigen blood test (PSA) is considered the only valid prostate screening method.  
 
PSA blood test

A PSA blood test's most significant benefit appears to be in men ages 55 to 69 years. The test can detect prostate cancer before it spreads, prompt early cancer treatment to slow the spread of the disease, and help men live longer. If you have an elevation in your PSA or an abnormal prostate exam, you should see a urologist. A repeat PSA, additional blood work, or an MRI may be ordered to identify your risk of prostate cancer further.
 
If your PSA is elevated and you need to see a urologist, the following may be possible next steps to be determined with your doctor. 
 
Digital rectal exam (DRE)

While a digital rectal exam isn't the primary screening method, it is used by urologists for further evaluation when an elevation in PSA has been detected. While a DRE exam may seem daunting, it is really quite simple. "The exam involves your doctor placing a lubricated, gloved finger into the rectum. The exam lasts about 10 seconds. During the exam, your doctor is assessing for enlargement, tenderness, lumps, or hard spots. The exam can provide additional information to your doctor that may not be assessed with a PSA blood test alone. Most men tolerate the exam very well and only note a small amount of pressure in the rectum, similar to when having a bowel movement," says Dr. Christiansen.
 
Additional blood and urine tests

Additional urine and blood tests may be ordered to rule out other possible causes of your symptoms.
 
Prostate MRI

A prostate MRI provides your doctor with a map of the prostate and helps identify any areas of concern. It may help determine if you need to undergo a prostate biopsy. If the MRI shows potentially concerning areas, a fusion biopsy may be performed, in which the MRI images are paired with real-time ultrasound images during the biopsy to take samples. A fusion biopsy has been shown to help improve detection of clinically significant prostate cancer. 

Prostate Biopsy

If necessary, a biopsy can be performed. An ultrasound probe is placed into the rectum, the prostate is numbed, and samples are taken of the prostate. "A diagnosis of prostate cancer cannot be made based on an exam, PSA, or MRI alone – a biopsy is required," says Dr. Christiansen. “We do everything we can to make the biopsy a comfortable and safe experience." 
 
Don't let a fear of the unknown keep you from a conversation with your doctor. Armed with the facts, consider making an appointment to discuss your history, risk, and screening options that are right for you. To make an appointment, call 800.922.0000.