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A Jefferson urologist breaks down when men should start getting screened, types of tests available and weighs in on the necessity of rectal exams.
Editor’s note: This article has been reviewed for accuracy from an earlier version posted in November 2020.
Every year, over 150,000 men are diagnosed with prostate cancer in the United States. Although common, most prostate cancer cases develop without any symptoms. That is why preventive screening is the key to catching it early.
In recent years, there has been a lot of debate over the timing and methodology of prostate cancer screenings, leaving some men confused about when and how to get a prostate exam. To find out more about screenings and when you should get them, we spoke with urologist Dr. James Ryan Mark.
In general, when should men start getting prostate cancer screenings?
Most doctors suggest that men should begin screenings for prostate cancer between the ages of 50 and 55. In certain cases, however, it may be a good idea to get a screening sooner than that. For example, if you have an immediate family member with prostate cancer, you’ll want to start getting screened between the ages of 40 and 45. Researchers have also found a trend of early-onset prostate cancer in Black men, who should also get screened in their early 40s. Additionally, men who have the BRCA2 gene mutation have been linked to more aggressive prostate cancer. So if women in your family have been diagnosed with breast cancer, typically associated with the BRCA gene, it may play into your prostate cancer screening plan.
What does a prostate cancer screening entail?
Traditionally, prostate cancer screenings consist of two tests: a prostate-specific antigen (PSA) blood test and a digital rectal examination (DRE). There has been some debate over the past few years as to whether or not the DRE is an essential screening tool for prostate cancer because PSA tests can be a strong indicator of prostate cancer. But some men can have prostate cancer along with normal levels of PSA and many men with an elevated PSA will not have prostate cancer. A DRE can help contextualize the PSA blood test.
What is a healthy PSA level?
This varies greatly depending on the age of the patient. We have a growing body of evidence that an elevated level of PSA in a younger man may be a predictor of prostate cancer. If you get a PSA test in your 40s and your levels are above 1.6 or so, it’s something to watch closely.
As you get older, your prostate naturally gets larger—it’s not always an indication that something is wrong. For men in their late 60s, a PSA of 5 is not very concerning, but for someone in their 40s, we may suggest a biopsy to see what’s going on. Additionally, a change in PSA levels can be more meaningful than a single value, so we will often track PSA levels over time and look at a patient’s health history as a whole before acting on a PSA test result.
Are there any early warning signs or symptoms for prostate cancer?
You will generally only notice symptoms from prostate cancer at a later stage if you haven’t been screened. The symptoms we pay attention to aren’t very specific to prostate cancer and are almost always caused by other non-cancer-related urologic conditions. Therefore, most men will get a PSA test to rule out prostate cancer if they experience pelvic pain, difficulty urinating, bone-related pain, unexplained weight loss, blood in urine and semen or signs of newly onset renal failure. Most prostate cancer, however, is found before men start to develop symptoms.
What’s your take on the necessity of rectal exams in prostate cancer screenings?
We have a lot of tools available to determine if a biopsy is necessary. A PSA blood test is one way to determine a patient’s prostate cancer risk profile, but it’s more of a gradient than anything. There are some men who have low PSA levels and are diagnosed with prostate cancer by an abnormal DRE. We also use DREs to stage cancer and select treatment options, determine how strongly to recommend a prostate biopsy given a patient’s PSA levels, or decide whether to do additional testing to see if a biopsy can be omitted.
In general, you should be open and honest with your doctor about your health history and concerns surrounding prostate cancer screenings. If patients don’t feel comfortable with a DRE, there are other options available to complement PSA screening. A urologist can help talk through all options to keep you and your prostate healthy.
[Main photo credit: iStock.com/Pornpak Khunatorn]