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Prostate cancer screening

What is a screening test?

‘Screening’ generally means looking for markers of early disease in people who have no symptoms[18]Reference 18:
Centers for Disease Control and Prevention. Prostate cancer screening: A decision guide. Accessed: 27 January 2009. View all
. Prostate is a gland in males, about the size of a walnut. It stores the fluid that makes up semen. Screening is different to many other tests which are performed when you have a problem or a symptom.  In that case the doctor is aiming to make a diagnosis.

What is prostate cancer screening?

There are two tests available that might help to find prostate cancer early.

  1. A rectal exam: This involves a doctor putting a finger in the rectumRectum is the part of the gut where solid waste is stored before it is passed from the body. to check for lumps on the prostate gland. Prostate cancerProstate cancer is when cancer cells divide and grow in the prostate gland. needs to be quite big for the doctor to feel it this way. So, this means that some cancers are missed using this test.
  2. A PSA test: A PSA test is a blood test that measures the amount of Prostate Specific Antigen (PSA) in the blood. PSA is a protein made in the prostate. All men have PSA in the blood and your body makes more PSA as you age[19]Reference 19:
    The Cancer Council NSW. (2007). Understanding prostate cancer: A guide for men with cancer, their families and friends. Accessed: 6 January 2009. View all
    . A high level of PSA can be a sign of prostate problems.

Having a rectal exam and a PSA test together may increase the chances of finding cancer if it is present. These tests alone cannot tell you for certain if you have prostate cancer. Further tests are needed.

Possible results from a PSA test

Men who have a PSA test will be told either that their:

  1. PSA level is in the normal range: If your PSA level is in the normal range, it is less likely that there is a problem with your prostate. However, there is a small chance that you could have prostate cancer even if your PSA test is in the normal range[20]Reference 20:
    Harris R et al: Screening for prostate cancer: an update of the evidence for the U.S. Preventive Services Task Force.[see comment]. Annals of Internal Medicine 2002, 137(11):917-929. View all
    . Like all tests, PSA tests are not always accurate.
    Or:
  2. PSA level is higher than normal: Around 10% of men who have a PSA test will have a PSA level that is higher than normal. This result means it is more likely that there is a problem with the prostate. This could be caused by prostate cancer or by an infection or a non-cancer (benign) condition (e.g., benign prostatic hyperplasiaBenign prostatic hyperplasia (or BPH) is a non cancer condition. It involves an increase in the size of the prostate gland.BPHBenign prostatic hyperplasia (or BPH) is a non cancer condition. It involves an increase in the size of the prostate gland.’ or prostatitisProstatitis is a non cancer condition. It occurs when the prostate becomes infected or inflamed.). Most men with a higher than normal PSA test result do not have prostate cancer[5]Reference 5:
    Carter HB: Prostate disorders. In: The Johns Hopkins White Papers. Baltimore, Maryland: Johns Hopkins Medicine; 2008. View all
    .

Note: when your PSA is in the normal range, the rate of change of your PSA levels may be more important than the actual level[5]Reference 5:
Carter HB: Prostate disorders. In: The Johns Hopkins White Papers. Baltimore, Maryland: Johns Hopkins Medicine; 2008. View all
.

Finding out if it is prostate cancer

More tests are needed if a man’s PSA level is higher than normal. This is the only way of finding out which men have prostate cancer and which men do not. These tests include a biopsy.  It involves a specialist ( urologist) placing an ultrasound device in the rectum to see the prostate and using a fine needle to take samples for analysis.  It's done with a local anaesthetic and you're given antibiotics to prevent a possible infection. A biopsy removes small samples of the prostate gland to test them for prostate cancer. Serious side-effects from having a biopsy are rare. A small number of men may develop a urinary tract infection or may experience fevers after having a biopsy[5]Reference 5:
Carter HB: Prostate disorders. In: The Johns Hopkins White Papers. Baltimore, Maryland: Johns Hopkins Medicine; 2008. View all
. Some men may also notice some blood in their urine, stools or semen[5]Reference 5:
Carter HB: Prostate disorders. In: The Johns Hopkins White Papers. Baltimore, Maryland: Johns Hopkins Medicine; 2008. View all
. If the biopsy shows you have prostate cancer, then you will need to decide what treatment is best for you.

Many men with a high PSA level will be told they do not have prostate cancer after they have had a biopsy or an ultrasound. It is still possible for them to have prostate cancer that was not found by the tests, but this is quite unlikely.

What happens after a man is diagnosed with prostate cancer?

If a man is diagnosed with prostate cancer he may be offered the following options:

  1. Watchful waiting: Some men will choose to ask their doctor to watch their cancer with regular tests before having any treatment. This is because some cancers are slow growing and may never cause a problem. This option also avoids the side-effects of prostate cancer treatment. However, there is a risk that the cancer may progress and become incurable with this option.
  2. Surgery to remove the prostate gland: If the cancer is confined to the prostate, this may remove all the prostate cancer. It is possible, however, that the cancer will return. Surgeons may offer different surgeries depending on the size of the cancer. These surgeries range from a radical prostatectomyRadical prostatectomy involves removing the whole prostate. to nerve-sparing surgeryNerve-sparing surgery is a type of surgery for prostate cancer in which the parts of the body needed for erections and urinating are not affected..
  3. Radiotherapy: This involves using x-rays aimed at the pelvis to kill the cancer cells. It is possible that this treatment may not remove all the cancer cells in the prostate gland.
  4. Brachytherapy: This is a newer treatment for prostate cancer. It involves placing radioactive material into the prostate cancer to kill the cancer cells. As with radiotherapy, it is possible that this treatment will not remove all the cancer cells in the prostate gland.

All cancer treatments have the potential to cause problems (i.e., side-effects). The most likely side-effects from prostate cancer treatment are impotenceImpotence is the inability to obtain or maintain an erection. and incontinenceIncontinence is the inability to control the loss of urine..

Will PSA testing stop me dying from prostate cancer?

Large research studies following men who have, and men who have not, undergone PSA testing showed varying results for the likelihood of dying from prostate cancer over 4 to 10 years.[21]Reference 21:
Postma R et al: Cancer detection and cancer characteristics in the European Randomized Study of Screening for Prostate Cancer (ERSPC) - Section Rotterdam: A Comparison of Two Rounds of Screening. European Urology 2007, 52(1):89-97. View all
[22]Reference 22:
Illic D et al: Screening for prostate cancer: A Cochrane systematic review. Cancer Causes Control 2007, 18:279-285. View all
[23]Reference 23:
Oberaigner W et al: Reduction of Prostate Cancer Mortality in Tyrol, Austria, after Introduction of Prostate-specific Antigen Testing. American Journal of Epidemiology 2006, 164(4):376-384. View all
. One study showed no difference[24]Reference 24:
Andriole GL et al: Mortality Results from a Randomized Prostate-Cancer Screening Trial. New England Journal of Medicine 2009, 360(13):1310-1319. View all
and another showed that PSA tested men were 20% less likely to die from prostate cancer over the 4 years of following them. [25]Reference 25:
Schroder FH et al: Screening and Prostate-Cancer Mortality in a Randomized European Study. New England Journal of Medicine 2009, 360(13):1320-1328. View all
. The research also suggests that about half of the cases of prostate cancer detected by PSA screening would never cause symptoms.[26]Reference 26:
Draisma G et al: Lead times and overdetection due to prostate-specific antigen screening: Estimates from the European Randomized Study of Screening for Prostate Cancer. Journal of the National Cancer Institute 2003, 95(12):868-878. View all
.  Side effects of treatment can sometimes cause death.  If we treat cancers that don't need treating then we inevitably cause harm to people who would otherwise have been well.  At present we are not able to identify which prostate cancers will cause harm and should be treated, and which will not.[

The next part of the website gives you information about your chances of being diagnosed with prostate cancer if you have a PSA test every year for the next 10 years. It also gives you information about your chances of dying from prostate cancer if you have a PSA test every year for the next 10 years. The numbers provided on the next two screens are only estimates. They are based on the age and family history details you provided at the beginning of the website and on your current risk of developing prostate cancer. The figures refer to a 10 year period only, because your risk of prostate cancer changes with age. The estimates we have provided use the best numbers from the latest evidence available. They may change in the future. Also, we have presented the best-case scenario for PSA testing, rather than the worst. That is, we provide the best numbers published for the outcomes of PSA testing.