WHAT IS SCREENING FOR PROSTATE CANCER?

Cancer screening means looking for cancer before it causes symptoms. The goal of screening for prostate cancer is to find cancers that may be at high risk for spreading if not treated and to find them early before they spread.

If you are considering a screening, learn about the possible benefits and harms of screening, diagnosis, and treatment, and talk to your doctor about your personal risk factors.

There is no standard test to screen for prostate cancer. The Prostate Specific Antigen (PSA) test and the Digital Rectal Examination (DRE) are two tests commonly used to screen for prostate cancer.

PROSTATE SPECIFIC ANTIGEN (PSA) TEST
The Prostate Specific Antigen (PSA) test is a blood test that measures the level of PSA in the blood. PSA is a substance made by the prostate. The levels of PSA in the blood can be higher in men with prostate cancer. The PSA level may also be elevated in other prostate conditions.

As a rule, the higher the PSA level in the blood, the more likely a prostate problem is present. But many factors, such as age and race, can affect PSA levels. Some prostate glands make more PSA than others.

Factors that might affect PSA levels
One reason it is hard to use a set cutoff point with the PSA test when looking for prostate cancer is that a number of factors other than cancer can also affect PSA levels.

Factors that might raise PSA levels include:
• An enlarged prostate. Conditions such as benign prostatic hyperplasia (BPH), a non-cancerous enlargement of the prostate that affects many men as they grow older, can raise PSA levels.
• Older age. PSA levels typically increase slowly as you get older, even if you have no prostate abnormality.
• Prostatitis. This is an infection or inflammation of the prostate gland, which can raise PSA levels.
• Ejaculation. This can make the PSA go up for a short time. This is why some doctors suggest that men abstain from ejaculation for a day or two before testing.
• Riding a bicycle. Some studies have suggested that cycling may raise PSA levels for a short time (possibly because the seat puts pressure on the prostate). However, not all studies have found this.
• Certain urologic procedures. Some procedures performed in a doctor’s office that affect the prostate, such as a prostate biopsy or cystoscopy, can raise PSA levels for a short time. Some studies have suggested that a digital rectal exam (DRE) might increase PSA levels slightly. However, other studies have not found this. Still, if both a PSA test and a DRE are being done during a doctor visit, some doctors advise having the blood drawn for the PSA before having the DRE, just in case.
• Certain medicines. Taking male hormones like testosterone (or other medicines that raise testosterone levels) may cause a rise in PSA.

Some things might lower PSA levels (even if a man has prostate cancer):
• 5-alpha reductase inhibitors. Certain drugs used to treat BPH or urinary symptoms, such as finasteride (Proscar or Propecia) or dutasteride (Avodart), can lower PSA levels. These drugs can also affect prostate cancer risk. Tell your doctor if you are taking one of these medicines. Because they can lower PSA levels, the doctor might need to adjust for this.
• Herbal mixtures. Some mixtures sold as dietary supplements might mask a high PSA level. It’s important to let your doctor know if you are taking any supplements, even ones not necessarily intended for prostate health. Saw palmetto (an herb used by some men to treat BPH) does not seem to affect PSA.
• Certain other medicines. Some research has suggested that long-term use of certain medications, such as aspirin, statins (cholesterol-lowering drugs), and thiazide diuretics (such as hydrochlorothiazide), might lower PSA levels. More research is needed to confirm these findings.

For men who might be screened for prostate cancer, it’s not always clear if lowering the PSA is helpful. In some cases, the factor that lowers the PSA may also reduce a man’s risk of prostate cancer. But in other cases, it might lower the PSA level without affecting a man’s risk of cancer. This could be harmful if it were to decrease the PSA from an abnormal level to a normal one, as it might not detect cancer. This is why it’s important to talk to your doctor about anything that might affect your PSA level.

DIGITAL RECTAL EXAMINATION (DRE)
For a digital rectal exam (DRE), the doctor inserts a gloved, lubricated finger into the rectum to feel for any bumps or hard areas on the prostate that might be cancer. The prostate is just in front of the rectum. Prostate cancers often begin in the back part of the gland and can sometimes be felt during a rectal exam. This exam can be uncomfortable (especially for men with hemorrhoids). Still, it usually isn’t painful and only takes a short time. The U.S. Preventive Services Task Force does not recommend DRE as a screening test because of a lack of evidence on the benefits.

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