Is screening right for you?
The decision is yours. Some medical experts
believe all men should be offered regular screening tests for
prostate cancer. Other medical experts do not recommend screening.
To help you decide, let’s begin with the basics.
The Prostate
and Prostate Cancer
What is the prostate?
The prostate is a walnut-sized gland that only
men have. It is part of the reproductive system that makes the fluid
that carries sperm. As you can see in the picture below, the
prostate is located in front of the rectum and just below the
bladder. The urethra (the tube that carries urine from the bladder
to outside the body) runs through the center of the prostate. As men
age, the prostate tends to increase in size. This can cause the
urethra to narrow and decrease urine flow.
What is prostate cancer?
Prostate cancer is made up of cells that do not
grow normally. The cells divide and create new cells that the body
does not need, forming a mass of tissue called a tumor. These
abnormal cells sometimes spread to other parts of the body,
multiply, and cause death.
What causes prostate cancer?
As with many types of cancers, medical experts do
not know what causes prostate cancer. They are studying several
possible causes.
Can prostate cancer be prevented?
Medical experts do not know how to prevent
prostate cancer. But they are studying many factors. They do know
that not smoking, maintaining a healthy diet, staying physically
active, and seeing your doctor regularly contribute to overall good
health.
How common is prostate cancer?
For the general population, a man in his lifetime
has about a
- 16 percent chance (1 in 6) of being diagnosed with prostate
cancer.
- 3 percent chance (1 in 33) of dying from prostate cancer.
The older you are, the greater the risk for getting prostate cancer.
See the chart below.
*Text description of chart
also available
Who is at increased risk for prostate cancer?
While all men are at risk for prostate cancer,
some factors increase risk
- Family history. Men with a father or brother
who has had prostate cancer are at greater risk for developing
it themselves.
- Race. Prostate cancer is more common in some
racial and ethnic groups than in others, but medical experts do
not know why. Prostate cancer is more common in African-American
men than in white men. It is less common in Hispanic, Asian,
Pacific Islander, and Native American men than in white men.
Is prostate cancer serious?
Some prostate cancers become a serious threat to
health by growing quickly, spreading beyond the prostate gland to
other parts of the body, and causing death. Yet other prostate
cancers grow slowly and never become a serious threat to health or
affect how long a man lives. Doctors can’t always be sure what
type of cancer is present in your particular case.
Among the leading causes of cancer death in men, prostate cancer is
second, behind lung cancer. When compared with all causes of death
in men over age 45, prostate cancer ranks fifth.
*Text description of
graph also available
What are the symptoms of
prostate cancer?
Many men with prostate cancer often have no symptoms. If symptoms
appear, they can include
- blood in the urine;
- the need to urinate frequently, especially at night;
- weak or interrupted urine flow;
- pain or burning feeling while urinating;
- the inability to urinate;
- constant pain in the lower back, pelvis, or upper thighs.
If you have any of these symptoms, see your doctor as soon as
possible. Keep in mind that these symptoms are also caused by other
prostate problems that are not cancer, such as an infection or an
enlarged prostate.
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Prostate Cancer Screening
What does “screening” mean?
Screening means looking for signs of disease in
people who have no symptoms. So screening for prostate cancer is
looking for early-stage disease when treatment may be more
effective. The main screening tools for prostate cancer are the
digital rectal examination (DRE) and the prostate–specific antigen
(PSA) test. The DRE and PSA test cannot tell if you have cancer;
they can only suggest the need for further tests.
What is the DRE?
The DRE or digital (finger) rectal examination is a quick exam for
checking the health of the prostate. For this test, the doctor
inserts a gloved and lubricated finger into the rectum. This allows
the doctor to feel the back portion of the prostate for size and any
irregular or abnormally firm areas.
What is the PSA test?
PSA stands for "prostate –pecific antigen." PSA is a
substance produced by cells from the prostate gland and released
into the blood. The PSA test measures the PSA level in the blood. A
small amount of blood is drawn from the arm.
The doctor checks the blood to see if the PSA level is normal. The
doctor may also use this test to check for any increase in your PSA
level compared to your last PSA test.
As a rule, the higher the PSA level in the blood, the more likely a
prostate problem is present. But many factors, such as age and race,
can affect PSA levels. Some prostate glands produce more PSA than
others. PSA levels can also be affected by
- certain medical procedures;
- an enlarged prostate;
- a prostate infection.
Because many factors can affect PSA levels, your doctor is the best
person to interpret your PSA test results.
How accurate are the screening tests?
No test is right all the time and that is true of the PSA test and
DRE. The PSA test is better at suggesting that small cancers are
present, especially those toward the front or sides of the prostate
gland, or deep within it. But the DRE can sometimes help suggest
cancers in men with normal PSA levels. That is why both the PSA test
and the DRE are usually performed.
If 100 men over age 50 take the PSA test
- 85 will have a normal PSA (though a small number of these men
will have a cancer that was missed by the PSA test).
- 15 will have a higher than normal PSA and require further
tests.
After further testing, results will show
- 12 do not have prostate cancer.
- 3 have prostate cancer.
What do medical experts say about
screening?
Medical experts agree that every man needs
balanced information on the pros and cons of prostate cancer
screening to help him make an informed decision. Balanced
information is important because medical experts disagree about
whether men should be screened regularly for prostate cancer.
Medical experts who encourage regular screening believe current
scientific evidence shows that finding and treating prostate cancer
early, when treatment might be more effective, may save lives. They
recommend that all men who have a life expectancy of at least 10
years should be offered the PSA test and DRE annually beginning at
age 50. They also recommend offering screening tests earlier to
African-American men, and men who have a father or brother with
prostate cancer.
Medical experts who do not recommend regular screening want
convincing evidence that finding early-stage prostate cancer, and
treating it, saves lives. They believe some of these cancers may
never affect a man’s health and treating them could cause
temporary or long-lasting side effects like impotence (inability to
keep an erection) and incontinence (inability to control the urine
flow, resulting in leakage or dribbling). Because they believe it is
unclear if the potential benefits of screening outweigh the known
side effects of treatment, they recommend that all men be given
information on the pros and cons of screening before making their
own screening decision.
When will medical experts know more?
Medical experts are working together on major research studies to
get answers. These studies are called clinical trials. They will
help determine whether a man who gets screened regularly is less
likely to die of prostate cancer than a man who does not get
screened. Clinical trials involve thousands of male volunteers and
take a long time. Results are expected in five to 10 years. They
should help experts know if screening for prostate cancer saves
lives.
Should I be screened for prostate cancer?
The decision is up to you and your doctor. Know your risk factors
for prostate cancer and the pros and cons of screening.
Pros
“I will take the screening tests because they will give me
peace of mind. It could mean finding a problem, taking further
tests, and treating a potentially serious prostate cancer. And
because there’s no way to tell if the prostate cancer will cause
problems in the future, I want it found early when treatments might
be more effective.”
Cons
“I will not take the screening tests until medical experts
agree that finding and treating prostate cancer in its early stages
reduce the chance of dying from it. Screening tests could lead to
further tests and treatment of a prostate cancer that may never
cause problems. And treatment can have serious side effects.”
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Follow-Up Testing
What if the results of your screening tests
indicate that you might need further testing?
Do not panic. Most men who go for further
testing do not have cancer. If your PSA test or DRE suggests a
problem, your doctor most likely will refer you to a urologist (a
doctor who has special training in prostate-related problems).
Additional testing is necessary to determine if the problem is
cancer or something else.
The urologist may perform a transrectal ultrasound — a small probe
inserted into the rectum that bounces sound waves off the prostate,
producing a video image. Transrectal ultrasound does not provide
enough specific information to make it a good screening tool by
itself, but some doctors find it useful as a follow up to a
suspicious DRE or PSA test.
If the urologist suspects cancer, tiny samples of the prostate may
be removed with a needle. This is called a biopsy. A biopsy is
usually performed in the urologist’s office. The samples are
examined under a microscope to determine if cancer cells are
present.
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Treating Prostate Cancer
What happens if prostate cancer is found?
No two men with prostate cancer are the same. Many factors affect
the decision whether or not to treat the disease: the patient's age,
whether the cancer has spread, the presence of other medical
conditions, and the patient's overall health.
When prostate cancer has been found in its early stages and has not
spread beyond the prostate, a doctor and his patient may decide upon
- watchful waiting — monitoring the patient's prostate cancer
by performing the PSA test and DRE regularly, and treating it
only if and when the prostate cancer causes symptoms or shows
signs of growing;
- surgery (radical prostatectomy) — removing the prostate;
- external radiation therapy — destroying cancer cells by
directing radiation at the prostate;
- internal radiation therapy (brachytherapy) — surgically
placing small radioactive pellets inside or near the cancer to
destroy cancer cells;
- hormone therapy — giving certain hormones to keep prostate
cancer cells from growing;
- cryotherapy — placing a special probe inside or near the
prostate cancer to freeze and destroy the cancer cells.
More advanced prostate cancers that have spread beyond the prostate
can be complex to treat and may be incurable. Patients should
discuss with their doctor the best course of action.
Do these treatments have side effects?
Side effects from prostate cancer treatment depend mainly on the
type of treatment, the patient’s age, and his overall health. Men
can experience pain, discomfort, and other mild to severe side
effects that may be temporary or may last a long time. Two important
side effects are impotence and incontinence. When a doctor explains
the treatment options, he or she can discuss how mild or severe side
effects might be, and how long they might last. Also, a doctor may
be able to perform surgery or prescribe drugs to relieve some side
effects.
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Conclusion and Resources
Thank you for reading this information. We
hope it helped you understand the prostate, prostate cancer, and the
different opinions on screening.
To decide whether screening is right for you, discuss the pros and
cons of screening with your doctor and the people important in your
life. For more information on prostate cancer screening, testing,
treatments, and studies, talk with a cancer information specialist
at
1-800-4-CANCER (1-800-422-6237), or visit the Web site: www.healthfinder.gov
and type in the words “prostate cancer.”
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