Prostate Cancer Screening for Men

What is prostate cancer screening?

Prostate cancer screening involves conducting a PSA blood test. This test measures the amount of prostate-specific antigen (PSA) in the blood. Every man will have a level of PSA detectable in their blood, as the PSA protein is produced by normal, as well as by malignant cells in the prostate gland.

The PSA test is not a specific cancer test, but rather a prostate test, forming one component of the prostate cancer screening process. In men with prostate cancer, the PSA reading will usually be higher than in those without. The aim of the PSA test is to detect prostate cancer at an early stage, so that the chances of curing the disease are improved.

What is prostate cancer and why is screening important?

The prostate is a walnut-sized gland that sits just below the bladder in men. Its function is to produce some of the components of semen. When the cells of the prostate gland grow in an abnormal and unregulated manner, prostate cancer occurs. There are different types of prostate cancer. Some types of cancers grow slowly, rarely causing the patient any harm, whilst others can spread to other parts of the body (metastasize), causing serious harm to the patient, and sometimes these can even result in death.

Most men who are diagnosed with prostate cancer won’t die from the disease. Still, prostate cancer is the cause of the second highest number of cancer-related deaths in Australian men, and as such it is a major health concern.

Prostate cancer screening is important, because prostate cancer rarely causes a man to experience any symptoms until it reaches an advanced (and often incurable) stage.

Is prostate cancer screening necessary for all men?

Prostate cancer screening has been scientifically proven to save lives. A large-scale European study with over 160,000 participants showed that PSA screening led to a 20% reduction in death from prostate cancer in men who were screened.

Despite this evidence, there has unfortunately been some controversy around the PSA screening test. This is largely due to the fact that PSA screening has the potential to detect low-grade tumours which would otherwise be undetected, never cause any symptoms, and would not generally require treatment. This may cause anxiety in some patients.

This is where the role of the urologist is particularly important in the prostate cancer screening process: the urologist will educate and manage the patient appropriately to avoid over-treatment in these cases.

PSA screening/prostate cancer screening remains an effective way to diagnose high-grade prostate cancers at an early stage, allowing them to be treated in a timely manner, giving the patient the best chance of cure.

Who should undergo prostate cancer screening?

Making a decision as to whether or not to undergo prostate cancer screening is a personal choice. The major benefit of undergoing prostate cancer screening is early detection, with improved chances of timely treatment and cure.

Men who are interested in determining their individual risk of having or of developing prostate cancer should speak to their family doctor about having a prostate cancer screening blood test (PSA blood test).

The general recommendation for prostate cancer screening for men is:

• At 50 years of age, if there is no family history of prostate cancer
• At 45 years of age if there is a first degree relative (father, uncle or brother) with prostate cancer.

How is a prostate cancer screening conducted?

Prostate cancer screening usually begins with the collection of a blood sample from the patient, to conduct a PSA blood test. The sample is sent to the laboratory for analysis. Results are usually reported as nanograms of PSA per millilitre (ng/mL) of blood.

It is important for patients to understand that there is no ‘normal’ level of PSA in the blood. As mentioned earlier, PSA will be detectable in the blood of all men who still have their prostate. There are a number of conditions which are not cancer such as an enlarged prostate (BPH), inflammation (prostatitis/ infection) that may also cause the PSA level to be elevated.

This is the main reason why the PSA blood test only forms part of the prostate cancer screening process. It also highlights the importance of monitoring PSA levels over time, rather than considering only a standalone reading.

What happens if the PSA is elevated on the prostate cancer screening test?

If the reading on the PSA screening test is elevated, generally your doctor will ask you to repeat the test in 4-6 weeks. This will help your doctor to determine whether or not it was a true reading. From there, you will be referred to a urologist, who will perform a comprehensive assessment to determine your individual risk. Your urologist will perform an examination and may recommend further investigation with a multiparametric MRI and transperineal prostate fusion biopsy. This procedure can definitively diagnose or exclude prostate cancer.

If a diagnosis of prostate cancer is made, then your urologist will ensure that you are fully informed of all of your options for management of your condition, including active surveillance in cases of low-grade, low-risk cancers, to avoid over-treatment.