Diagnosis

There is great uncertainty and controversy over whether the benefits of regular screening for prostate cancer outweigh the risks for most men. Prostate cancer is often slow growing. Doctors cannot yet predict accurately which early-stage tumors pose a risk of being aggressive and need treatment, and which tumors should be left alone. The concern is that routine screening for early detection of tumors may lead to invasive and unnecessary treatment.

In general, the current consensus is that there is no “one size fits all” guideline for who should receive prostate cancer screening and at what age. Before deciding to be tested, men need to discuss the pros and cons of screening with their doctors.

Candidates for Annual Screening. The best age to start annual screening is under debate. Major medical organizations generally recommend that:

• Men ages 50 - 75 should be offered annual screening with the PSA test and digital rectal exam. However, the United States Preventive Services Task Force notes that there is insufficient evidence to determine whether routine prostate cancer screening has benefits. If a man chooses to be tested, he should be screened yearly with a PSA test and digital rectal exam.
• Men with a family history of prostate cancer and all African-American men should consider annual screening at about age 40 - 45.
• PSA testing is not recommended for men over age 75. Because of shortened lifespan, responding to abnormal PSA results in this age group may lead to overly aggressive treatment.

Standard Screening Tests for Early Detection

Two standard tests are used for early detection of prostate cancer:

• PSA test. The PSA blood test measures the level of a protein called prostate-specific antigen. It is able to detect early prostate cancer, although it has limitations.
• Digital rectal examination (DRE). The DRE is a physical examination. The doctor inserts a gloved and lubricated finger into the patient's rectum and feels the prostate for bumps or other abnormalities.

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Review Date: 07/26/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)