Prostate Screening

Screening for Prostate Cancer

While there is some controversy among medical thought leaders on when and how often to screen for prostate cancer, WakeMed’s urology team follows the American Urological Association (AUA) guidelines as follows:

• PSA screening should begin for men at age 40 years who are at increased risk of developing prostate cancer. Risk factors include black ancestry, germline mutations or strong family history of prostate cancer.
• PSA screening should begin between the age of 45-50 years for men without increased risk factors.
• For men over the age of 69 years, patients should engage in shared decision making with their physician on whether to continue PSA screening.

Generally, the AUA recommends men get screened every two years.

What to Expect from a Prostate Cancer Screening

In most cases, screening for prostate cancer involves two separate tests — a prostate-specific antigen (PSA) test and a digital rectal exam (DRE).  Together these two tests can provide your urologist with the best overall understanding of your prostate health.

• Prostate-specific antigen (PSA) test:  This simple blood test checks the levels of PSA found in your blood. It’s not a definitive test, though, since an elevated PSA level just increases your chance of having prostate cancer. There is no set PSA number that tells us for certain that a man does or doesn’t have prostate cancer. Normal" PSA levels depend on the patients age, so discussion with your doctor is essential. For example, for a man under 50, a normal PSA should be less than 2. For men between 50-70, A 'normal" PSA should be between 2-4. For men over 70, it depends on many factors and the previous trend of information to determine when additional evaluation is needed. It is also important to know that recent sexual activity, urinary tract infection, or chronic prostate inflammation can all affect the PSA.
• Digital rectal exam (DRE): In this exam, your urologist will briefly insert a gloved, lubricated finger into the rectum to check the prostate for potential abnormalities such as lumps, bumps or hard areas that could indicate cancer.

 While many primary care doctors are shying away from performing PSA and rectal examination, it can sometimes be up to the patient to advocate for their own health and request these tests to be done.

Abnormal results for either of these tests don’t necessarily confirm that you need treatment for prostate cancer. Because prostate cancer is a relatively slow-growing cancer, it’s not always treated right away. Depending on your health and other risk factors, your urologist may recommend either further testing (such as a biopsy) or a “watchful waiting” approach that may involve future, more frequent screening.