For men in the US, prostate cancer is the most common cancer and the second leading cause of cancer death. Cancer screening, especially once we reach a certain age, is an important part of living a healthy life. Merely knowing what the common prostate screening tests are and how they work can help you feel more comfortable and ready to discuss them with your doctor.
When to screen for prostate cancer
Men 40 and older should consider screening for prostate cancer. If you have a family history of prostate cancer or if you are of African ancestry, you may be at higher risk. We recommend discussing prostate cancer screening with your healthcare provider early to determine a right time for you.
Different options for prostate cancer risk assessment and screening
You have probably heard about prostate-specific antigen blood tests (or PSA tests), but there are several screening tests to assess your risk of prostate cancer.
Following is a list of common screening methods and follow-up tests for a patient undergoing prostate cancer risk assessment and diagnosis. Your doctor may or may not recommend some of these tests, but a broad understanding of what they are may be useful when you have conversations with your doctor. Every individual requires a unique path of care; you and your healthcare provider should decide what is best for you.
A prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. A PSA test is a common blood test to screen for prostate cancer. The higher the PSA, the higher the possible likelihood of prostate cancer.
It’s important to note that an elevated PSA level can occur for many reasons other than prostate cancer, including an enlarged prostate gland, prostate infection, recent sexual activity, or vigorous exercise. In fact, three out of four men with an elevated PSA do not have prostate cancer. Often, an elevated PSA result will lead to additional follow up, such as biomarker testing, to help determine whether prostate cancer is present.
Digital rectal examination (DRE)
Understanding what a DRE is and knowing what to expect can help you feel more prepared and less apprehensive about the procedure. Your prostate gland sits just in front of your rectum. In a digital rectal exam, or DRE, your doctor examines for any bumps or hard spots on the prostate gland, which might indicate cancer and be a signal that further testing is needed.
Your doctor might want to examine more if other screening methods detect something potentially abnormal. One method is to get a better view of the prostate using transrectal ultrasound. The ultrasound probe emits sound waves that bounce off surrounding tissue, including the prostate gland, and these “echoes” produce an image, or sonogram, your doctor can see on a screen. This is an outpatient procedure that takes about 15 to 30 minutes.
Magnetic Resonance Imaging (MRI) uses a combination of radio waves and powerful magnets to render a detailed picture of your prostate gland. Your doctor may use an MRI scan to assess the presence of prostate cancer and determine if it’s necessary to take a tissue biopsy. A biopsy is when a doctor takes a sample of tissue for further examination. If a biopsy is needed, an MRI scan can help your doctor guide where they should sample tissue. The scan itself is painless.
Urine biomarker test
The National Cancer Institute defines a biomarker as a molecule found in the body (in blood, other body fluid, or tissue) that is a sign of a normal or abnormal process, or of a condition or disease. A liquid biomarker test uses a urine sample to see which biomarkers are in your body that could signal a risk of prostate cancer. What these tests do is measure personalized information to determine the percent likelihood that you could have clinically significant prostate cancer, which is cancer for which immediate treatment is usually recommended. This personalized clinical data enables you and your doctor to determine together if a biopsy or further tests are needed.
If you have an elevated PSA level, your doctor could recommend you have a prostate biopsy. In a prostate biopsy, your doctor uses a thin needle to extract small tissue samples from different areas of your prostate gland. A prostate biopsy is usually an outpatient procedure. Biopsy procedures can vary according to your condition and your healthcare provider’s practices, so talk to your doctor to know what to expect.
Familiarizing yourself with these different methods can make it easier to talk about your options with your doctor. The best way to choose the right screening test(s) for you is to consult with your healthcare provider. The survival rate of prostate cancer can be 100 percent if it is diagnosed early. Being proactive, learning your options, and having the tools to start the conversation with your healthcare provider can bring peace of mind to you and your family.