Prostate cancer screening: It could save your life

Prostate cancer tops the list of cancers in men, second only to skin cancer. According to the American Cancer Society, one out of seven men are diagnosed with prostate cancer, affecting more than 233,000 men each year and killing almost 30,000 annually. If caught early, prostate cancer is 90-95 percent curable, making screenings all the more important.

“The prostate-specific antigen (PSA) exam is the gateway to information about a man’s risk for the disease,” said King Scott Coffield, M.D., professor of surgery and urology at the Texas A&M Health Science Center College of Medicine. “It’s one of the most effective ways to help detect prostate cancer, and by simply giving blood, you could save your life.”

PSA is a protein produced by cells of the prostate gland. PSA tests measure the level of PSA in a man’s blood; elevated levels can point to the possibility of prostate cancer, but are also associated with a number of benign prostate conditions that do not necessarily lead to cancer.

Who should be tested, and how often?

According to the American Urological Association (AUA) Guidelines Panel, men with increased risk — who either have a family history of breast or prostate cancer, or are African American — should start the discussion about beginning to screen for prostate cancer between the ages of 40 to 54.

Those with average risk should begin screening at 55, though there is no definite recommendation on how often you should be screened. To decrease the risk of false positives and over-diagnosis, one suggestion made by the panel is to wait longer, two or more years, between screenings when the PSA level is low enough to allow an increased interval between PSA check.

Men 70 or older, or men who have a life expectancy of 10 to 15 years, do not necessarily benefit from the screening, and for this reason, the AUA panel recommends against being screened. Men in these age groups should consult with their primary care providers and carefully consider the best options for them.

“It’s important to discuss with your primary care physician your options to make a well-informed decision on when to begin PSA exams, and how often to obtain them,” Coffield said.

I’ve been tested, now what?

PSA tests draw blood, and that blood is sent to a lab to be examined. You should hear back about your results within several days.

“The PSA is a simple blood test with a normal range of 0-4 nanograms per milliliter,” Coffield said. “Elevated PSA levels don’t always mean cancer, and that’s why we also rely on prostate examination, age, family history and medical history to determine the risk factor for each individual.”

Generally, the higher the PSA level, the more likely that cancer is present. That can be misleading, though, as the amount of PSA in the blood tends to increase with age.

Normal PSA levels are:

• Ages 40–49: 0 to 2.0–2.5 nanogram/milliliter
• Ages 50–59: 0 to 3.0–4.0 nanogram/milliliter
• Ages 60–69: 0 to 4.0–4.5 nanogram/milliliter

If you have elevated levels, your physician will likely have you repeat the PSA test after abstinence from sexual relations for 10 days. If the PSA is still elevated, you should see a urologist for a consultation. There isn’t necessarily cause for concern, though: PSA levels may be elevated due to a number of benign prostate conditions, including inflammation or enlargement of the prostate, neither of which have been found to lead to prostate cancer, Coffield said.

The tests for screening prostate cancer are by no means perfect, but Coffield has hope for the future.

“PSA tests have been a revolutionary tool in the diagnosis of prostate cancer,” Coffield said. “It continues to be used today because providers understand its benefits and limitations. PSA tests are used in multiple ways to help patients manage prostate cancer. We are always looking to improve PSA’s diagnostic efficacy, and I fully expect that better diagnostic testing will be identified to improve  prostate cancer detection.”