Who should be screened for prostate cancer?
Prostate cancer is among the most commonly diagnosed cancers for men in Maine. It is also the second leading cause of cancer death among all men in the US. Prostate cancer screening tests are not 100% accurate. A positive result could lead to treatment that may not be necessary. Your doctor can help you make an informed decision about whether prostate cancer screening is right for you. Testing options include:
- Prostate specific antigen (PSA) test: This test checks a man’s blood for high PSA levels, a marker for prostate cancer. High PSA levels also can indicate other conditions, including inflammation or infection of the prostate. Certain medicines, a patient’s medical history, and an enlarged prostate also can affect PSA levels.
- Digital rectal exam (DRE): During this test, your doctor will check your prostate manually, through the rectum, for lumps or other abnormalities.
More About Prostate Cancer Testing and Diagnosis
- For men under age 45, no routine PSA screening is needed.
- For men aged between 45-55, no routine PSA screening is needed for healthy men; however for patients who are Black or have positive family history of more than one family member with prostate cancer, a one-time PSA level at 45 may be appropriate to provide a baseline for future PSA test results. In all cases, men should have a discussion with their physician about benefits and risks.
- For men aged between 55-69 with life expectancies greater than 15 years, decisions about PSA tests should be based on a shared decision between patient and physician, acknowledging the known risks and benefits. If PSA screening is elected, it may be appropriate to have every 1-2 years. Decision-making should emphasize that not every cancer detected needs to be treated and that a wide spectrum of effective treatments are available.
- For men >70 years old, no routine PSA screening is needed. For men in excellent health, screening until age 75 may be appropriate as decided by the patient and physician.
If a PSA or DRE test detects an abnormality, your doctor may recommend a prostate biopsy. A prostate biopsy can be performed with a standard transrectal ultrasound or a MRI/Ultrasound Fusion Guided Biopsy. Your doctor will discuss which approach is right for you.
- Transrectal ultrasound (TRUS): Using ultrasound images for guidance, the Urologist will remove small samples (biopsy) which are then looked at under a microscope. Most urologists will take about 12 core samples from different parts of the prostate. This is done in the office setting.
- MRI/Ultrasound Fusion Biopsy: The MRI/Ultrasound fusion biopsy begins with a MRI of the prostate. The MRI images are read by a trained Radiologist and abnormal areas are outlined if present. These images from the MRI are fused with the real time ultrasound at the time of the biopsy. Any abnormal areas that have been identified are targeted. In addition to the targeted biopsy, an additional standard sampling of the prostate (12 biopsy cores, as above) will be performed. If no suspicious areas were identified on the MRI, only the standard 12 core transrectal ultrasound-guided non-targeted biopsy will be performed.