Screening and Diagnosis
The prostate specific antigen (PSA) blood test is widely available for screening men for prostate cancer. However, there is great uncertainty over whether regular screening has major benefits for most men. The most recent guidelines from the U.S. Preventive Services Task Force report that there is no conclusive evidence that routine prostate screening saves lives. Indeed, it may lead to invasive testing and treatments for many men who, considering the slow growth of the cancer, might derive no benefits from them. It is a difficult subject and men must discuss all aspects carefully with their doctor.
A 2006 study in the Archives of Internal Medicine also suggested that screening tests for prostate cancer may not reduce men’s risk of death. The small study of 1,000 men found no differences in survival between men who had prostate specific antigen tests or digital rectal exams, and men who were not screened. Doctors should inform men of the uncertainty of prostate cancer tests so that patients understand the relative risks and benefits of screening
Standard Screening Tests for Early Detection. Currently, two standard tests are used for early detection of prostate cancer:
- Digital rectal examination (DRE). With the DRE, a doctor palpates the prostate in order to feel lumps or masses.
- 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.
If the digital rectal examination indicates the possible presence of cancer, regardless of the PSA results, a doctor may also obtain a visual image of the prostate through an ultrasound procedure called transrectal ultrasonography (TRUS). Only a biopsy, however, in which a tiny sample of prostate tissue is surgically removed, can actually confirm a diagnosis of prostate cancer.
Candidates for Annual Screening. Until major studies report on the survival benefits of prostate screening, expert groups recommend the following:
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