Understanding prostate cancer screening

September 4, 2024

Providence Health Team

[5 MIN READ]

When prostate cancer is confined to the prostate, there is an almost 100% chance that it can be cured with treatment.
The prostate-specific antigen (PSA) test is a good first step in screening for cancer. Doctors can also use other tests to determine if a man likely has cancer.
Men who are at average risk for prostate cancer should start screenings at age 50.

Understanding prostate cancer screening

In the United States, about one in eight men will be diagnosed with prostate cancer in their lifetime. Other than skin cancer, it’s the most common cancer for men in this country. Fortunately, diagnostic tests have advanced tremendously in recent years, which means men who have prostate cancer are much more likely to catch it early. That increases their chance for a cure.

The prostate is a walnut-shaped gland in males that produces semen, the liquid that nourishes and transports sperm. The gland is located below the bladder and in front of the rectum, and it tends to grow larger as a man gets older.

What is prostate cancer?

The vast majority of prostate cancers are adenocarcinomas, which means they develop from the gland cells in the prostate. Many of them grow slowly and are confined to the prostate gland. “We tell patients that as long as the cancer is confined to the prostate, the likelihood of a cure is close to 100%,” says Mehran Movassaghi, M.D., the division chief of urology and director for men’s health at Providence Saint John’s Health Center in Santa Monica, California.

In some cases, such as when a man is over 75 when he receives his diagnosis, active surveillance may be a better option than treatment. The cancer may be so slow-growing that the man would die from other causes before being affected by the cancer.

Screening for prostate cancer

The screening test that is most closely associated with prostate cancer is the prostate-specific antigen (PSA) test. PSA is a protein produced by the prostate and found mostly in semen.

“PSA has nothing to do with prostate cancer,” says Dr. Movassaghi. “The only reason it was used as a screening tool is because men who have prostate cancer were found to have an elevated PSA level.”

Since doctors didn’t have any other method of screening for prostate cancer 10-20 years ago, they checked a man’s PSA level through a blood test. In the past, a PSA level of 3 or 4 was considered “normal” vs. “abnormal.” But extensive research has shown that high PSA test results don’t always mean there’s cancer— and a low level of PSA doesn’t always guarantee no cancer.

“Because the PSA test is not perfect, there was a while when primary care providers were no longer recommending that men undergo this screening,” says Dr. Movassaghi.

Over the past decade, however, more sensitive prostate cancer tests have been developed, including magnetic resonance imaging (MRI), blood tests and urine tests. “A PSA works really well as a first step,” says Dr. Movassaghi. “If a patient has an elevated PSA, then we will continue other kinds of testing to determine whether he should undergo a prostate biopsy for cancer.”

Another screening tool for prostate cancer is a digital rectal examination (DRE), during which a doctor inserts a gloved finger into the rectum and feels the back wall of the prostate gland for enlargement, hard spots, lumps or tenderness.

When should you undergo prostate cancer screening?

The American Cancer Society recommends that men talk to their health care provider about whether to be screened for prostate cancer. The discussion about screening should take place at:

Age 50 for men who are at average risk of prostate cancer and will likely live another 10 or more years.
Age 45 for men at high risk of developing prostate cancer. This includes African American men and men who have a first-degree relative (father or brother) diagnosed with prostate cancer at an early age (younger than age 65).
Age 40 for men at even higher risk (which includes men who have more than one first-degree relative who had prostate cancer at an early age).

Is it possible to prevent prostate cancer?

Prostate cancer is a “disease of aging,” which means that the older a man becomes, the more likely he is to receive a prostate cancer diagnosis. However, there are other risk factors — in addition to age — that are also unavoidable:

Race – Black men’s chances of developing prostate cancer are double that of white American men.
Genes – If you have a family history of prostate cancer, you are at greater risk of getting it, too.

That said, you can adopt a lifestyle that lowers your risk for prostate cancer. “More and more studies point toward adopting a Mediterranean diet,” says Dr. Movassaghi. That includes eating mostly vegetables, fruits and whole grains, focusing on plant-based foods and healthy fats.

Dr. Movassaghi also recommends participating in regular exercise, including 35 minutes of high-intensity activity every day. Not only can that prevent prostate cancer, he says, but it can also be good for men who already have prostate cancer. “A lot of times men who have prostate cancer feel like they have no control,” he says. “This is a way for them to regain control.”

Contributing caregiver

Mehran Movassaghi, M.D., is the division chief of urology and director for men’s health at Providence Saint John’s Health Center in Santa Monica, California.

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