Screening for Prostate Cancer: In very simple terms, Cancer screening means looking for any evidence of cancer before it causes any symptoms. As it is obvious, the idea behind screening is to detect any cancer in people who are at risk, before the cancer can spread or cause any harm. Also, the sooner a cancer is detected, the better outcome can be expected with early intervention and prompt treatment.
It is important to understand that screening is not a one time test. Screening term refers to all the methods which a doctor may adopt in order to best detect any abnormal cell growth. This test is recommended at specific time intervals, specially to those at risk so that any smallest cancer can be detected as soon as possible.
I have written in detail about the risk factors that predisposes someone for prostate cancer. Therefore it is very important to learn about screening as well. In short, people who have a family history of prostate cancer, who are over the age of 50 or 60 – these are the people who specifically should start with prostate cancer screening as soon as they reach the age of 45+
In general, we follow the following recommendations when it comes to screening for prostate cancer:
- Males who are above the age of 55 years must make a conscious decision about getting screening for prostate cancer with the help of PSA (Prostatic Specific Antigen).
- Males who are have a risk of prostate cancer, should meet their urologist and speak about the benefits and harms of getting screened for prostate cancer.
- Men over the age of 75 years do not need regular screening unless symptomatic.
How is Prostate Cancer Screening Performed?
Prostate cancer screening is a routinely performed non invasive procedure. Over the years, new ways of screening have come up as medical science continues to grow. Most commonly used methods for performing Prostate Cancer Screening are –
- Digital Rectal Examination for Prostate Cancer
If we quickly refer to the anatomy of pelvic organs, prostate is situated immediately in from of anterior wall of rectum. In digital rectal examination, the urologist inserts a gloved, lubricated finger in to the rectum of the patient and feels for the prostate.
In case of cancer, the urologist can find any enlargement of the prostate. He can comment upon the hardness and surface texture of the prostate. If the surface of the prostate feels irregular, hard or variegated, then the urologist suspects the disease.
- Prostate Specific Antigen
Prostate Specific antigen is a protein that is secreted into the blood by the prostate gland. It is a very important way of screening for prostate cancer. It is done with the help of a simple blood test. Men suffering from prostate cancer have high levels of PSA. However, PSA is not specific to prostate cancer. Which means, the level of PSA can be high in other conditions too such as
a. Benign Prostatic Hyperplasia (BPH)
b. Prostatic Infection (Acute or Chronic)
c. Certain Medications
d. Certain Medical procedures.
Most healthy men with healthy prostate have PSA levels under 4 Nanogram/mL of blood. If the PSA level is high, ie. Above 4 ng/mL, then the urologist may suggest additional tests like Ultrasonography and a Biopsy.
Men with PSA levels between 4 to 10 ng/mL have 1 in 4 chances of developing prostate cancer. And if the PSA level is more than 10 ng/mL, then the chances of having prostate cancer becomes 50%. Therefore, the levels of PSA are important as they directly indicate the risk of cancer.
- Prostate Cancer gene 3 (PCA3) RNA test
If a patient has high PSA, then we do biopsy. If the biopsy report comes negative and yet the PSA stays high, we can do a very modern test called Prostate Cancer gene 3 test. This test is done by taking a urine sample to look for the amount of PCA3 RNA in the urine after Digital rectal examination. If the PCA3 RNA is high, then the biopsy may be repeated to diagnose the problem.
What are the PROs of PSA Screening?
- PSA Screening can help detect prostate cancer early.
- Cancer is easier to treat and becomes more likely to get cured when diagnosed in very early stages.
- PSA test can be done very easily with the help of a simple blood sample.
- Screening is important for reassurance. For example, when a person gets the test done, the PSA levels give an idea if he has the cancer or not. If the cancer is suspected and detected, early treatment usually has very good prognosis in prostate cancer cases.
- As per data from a leading American journal, the number of deaths from prostate cancer have reduced since the time PSA test for screening has become available.
What are the CONs of PSA Screening?
- Some prostate cancers are very slow growing type. Which means, they never spread beyond the capsule of the prostate gland.
- PSA test is not a direct indicator of cancer. So sometimes PSA levels can be elevated in patients suffering from other problems like Benign prostatic enlargement, Prostate infection etc, these are called “False Positives”. This may cause anxiety among patients when they become apprehensive about undergoing PSA screening.
- Some rare types of prostate cancers may not produce enough PSA to elevate their levels in blood. Such rare incidences are called “False Negatives”. In this case, although the PSA levels are shown normal, the person actually has cancer. Therefore, in our hospital, to avoid this confusion, we offer ultrasonography along with PSA for screening for prostate cancer in high risk individuals.
Prostate Cancer Screening at Institute of Urology, Jaipur
If you know someone in your family has had Prostate Cancer, we highly recommend you start undergoing screening specially after the age of 50 years. Starting a screening process is very simple. You just need to meet us at the hospital and discuss about it. After ascertaining whether you need screening or not, the urologist can suggest an appropriate step.
Screening process involves a very simple blood test for PSA every 6 months. This can be combined with an ultrasound exam whenever needed to rule out any rare possibilities. Remember, screening is done only once every 6 months, so it is better to get it done so that one can avoid any chances of cancer at all.
For any other questions or queries, please note I am available for consultation at Institute of Urology, C Scheme, Jaipur. You can also WhatsApp me or give me a call at 8601539297. For booking an appointment for a personalised consultation, please contact 98290 13468.