Cancer screening becomes more important as we grow older, particularly if we have been exposed to risk factors such as smoking or hazardous chemicals, or if we have a family history of cancer.
Prostate cancer is the second leading cause of cancer death in the U.S., killing some 2.5% of American men; advanced prostate cancer is incurable. Screening can find it early – before it spreads – offering a chance for cure. Most prostate cancers grow slowly, and those most likely to benefit from screening are men aged 50 to 65. Those over 70 benefit the least from testing because they are more likely to die of other causes (such as coronary heart disease) before the cancer becomes apparent.
The American Cancer Society recommends yearly prostate exams comprising a prostate specific antigen (PSA) test and a digital rectal exam, beginning at age 50, to men who have at least a ten-year life expectancy. They also recommend screening begin at age 45 in men who are at high risk, including African Americans or those with a strong family history (two or more first-degree relatives) of prostate cancer.
Usually, if both the digital rectal exam and the PSA test are negative, a man can be reassured he doesn't have prostate cancer. Men with a high result may be advised to have a biopsy to find out if cancer is present.
Digital Rectal Exam
This exam can be done during a routine office visit. While you bend over, the doctor inserts a gloved, lubricated finger into the rectum to feel for any type of growth. The prostate gland is located next to the rectum, and most cancers begin in the area of the gland that can be reached by a rectal exam. This test can be uncomfortable but isn't painful. It should be done by a health care worker trained in recognizing subtle prostate abnormalities. If any irregular or abnormally firm area is detected, further tests will be done to determine whether the abnormality is cancerous. A digital rectal exam is less effective in detecting prostate cancer compared with a PSA test.
Prostate Specific Antigen (PSA) Exam
Screening for prostate cancer with a blood test for prostate-specific antigen (PSA) is an option that some men may want and others will not. In fact, even doctors disagree over whether or not to recommend it.
The test involves a quick blood sample, usually taken from your forearm. The sample is collected in the morning, if possible. Interpreting test results is the test's main problem. Results under 4ng/ml are usually considered normal. Results over 10ng/ml are high, and anything in between 4 and 10 is considered borderline. The higher the value, the more likely that prostate cancer is present. However, elevated levels don't necessarily mean a diagnosis of prostate cancer. They can result from other conditions, such as benign prostate enlargement and inflammation of the prostate.
It should also be noted that PSA levels tend to rise with age, so a borderline reading in an 80-year-old man might be less worrisome than one in a 50-year-old. For this reason, some doctors recommend comparing PSA readings to age-specific reference ranges.
The test isn't perfect: not only do high values not always predict prostate cancer, but men with negative or borderline values may in fact have cancer.
Men between the ages of 15 and 35 should have a testicular exam at every physical examination, at least every two to five years.
Women aren't the only people who should be doing routine self exams for cancer. Young men between the ages of 15 and 40 should perform monthly testicular exams; after 40 it should be every couple of months. Self-examination involves rolling each testicle gently between the thumb and fingers of both hands, and it is best done after a warm bath or shower. If you notice any bumps, tenderness or hardness, contact your doctor immediately.