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When should I get a prostate exam?

When should I get a prostate exam?

Written By: SERO Staff

When should I get a prostate exam?

Prostate cancer screening tests have been considered standard practice in preventative care for middle-aged men for the last 30 years. One in every seven American men will develop prostate cancer at some point in his lifetime, and for a long while, general wisdom held that regular prostate cancer screenings—via prostate exams or blood tests—would help reduce health complications and death rates related to prostate cancer.

Given the long-standing prevalence of prostate cancer screening, men may therefore wonder: When should I get a prostate exam or blood test to screen for prostate cancer?

Recently, the answer to this question has become more complicated.

New Thinking in Preventative Screening

In healthcare terminology, “screening” refers to medical testing used to detect diseases and illnesses before the patient has shown any symptoms. Screening tests are used to safeguard against common diseases or diseases that the patient may be at higher risk of developing.

Preventative screening can be particularly important for people who are at high risk for certain diseases, such as prostate cancer. Cancer screening saves lives, since cancer treatment is most effective, and chances for curing the disease are highest, when diagnosed in the early stages.

At the same time, researchers are still uncertain whether more screening leads to better health overall. While prostate cancer death rates have dropped since the introduction of widespread screening in the 1990s, some researchers believe that other factors—such as more effective treatment options—may actually be responsible for the decline.

While the medical community has yet to reach consensus on the issue, many leading healthcare organizations, including the American Cancer Society, Mayo Clinic, and National Institute of Health, encourage doctors to recommend testing on a case-by-case basis, rather than performing tests on all patients as a standard practice.

Before deciding whether or not to undergo testing, men should weigh the potential risks and benefits of prostate cancer screening, review medical history and personal risk factors for prostate cancer with their physician, and arrive at an informed conclusion.

Types of Prostate Cancer Screening

There are two tests used to screen for prostate cancer:

Digital Rectal Exam (DRE). The prostate, which is part of the male reproductive system, can be accessed through the rectum. During a DRE, a doctor inserts one finger into the rectum to check for abnormal growths or enlargement of the prostate. If a tumor has formed as the result of prostate cancer, the prostate may be much larger than normal, or may form hard lumps.

By Cancer Research UK (Original email from CRUK) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

Prostate Specific Antigen Test (PSA). Antigens are substances created by our immune system to fight disease. Antigens that are created to fight disease in one part of the body are different from those in other parts of the body. The PSA is a blood test that counts the level of antigens in a man’s blood that have been created to work in the prostate gland. If prostate antigens are high, it may indicate diseases of the prostate, such as cancer.

When should I get a prostate exam or PSA test? In determining the answer, men should consider both the benefits and risks.

The Benefits of Screening

When DRE or PSA results are abnormal, additional tests will be performed to confirm or disprove the presence of cancer. Typically, when cancer is diagnosed with one of these tests, it will be at an early stage and will be easier to treat and cure. Early-stage treatment may be less extensive, which might prevent side effects, such as erectile dysfunction and incontinence.

The Risks of Screening

Neither of the two methods of screening for prostate cancer is 100% accurate. Occasionally, results will return a false positive—indicating abnormal conditions, even if the patient has no cancer. In the case of a false positive, men may undergo unnecessary procedures, such as prostate biopsy, which can have negative side effects and lead to health risks.

Also, prostate cancer often grows very slowly. In some cases, a man may have prostate cancer that never causes serious problems. A slow growing cancer may never even cause symptoms.

However, those diagnosed with cancer tend to get treatment. Cancer may not always grow at the same rate, or in some cases could suddenly spread and become more serious, so many people choose not to risk it and decide to get treatment. Treatment for prostate cancer, such as surgery and radiation, may cause serious side effects, possibly affecting quality of life. 

​In these cases, it may be better for some men, especially men who are older or have other health problems, to simply live with prostate cancer.

According to the American Cancer Society:

“Until more information is available, you and your doctor should decide whether you should have tests for prostate cancer. There are many factors to take into account, including your age and health. If you’re young and develop prostate cancer, it may shorten your life if it’s not caught early. Screening men who are older or in poor health is less likely to help them live longer. This is because most prostate cancers are slow-growing, and men who are older or have major health problems are more likely to die from other causes before their prostate cancer grows enough to cause problems.”

Finding the Answer

So: when should I get a prostate exam or PSA test?

The American Cancer Society recommends talking to your doctor about screening in the following cases:

Age 50 for men who are at average risk of prostate cancer and are expected to live at least 10 more years.

Age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).

Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

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