Screening

How Do I Know If I Have Prostate Cancer?

“Know the risks. Beat the odds.” APCF

There are two tests used to help doctors screen for prostate cancer. They are:

  • Prostate-Specific Antigen (PSA) blood test
  • Digital Rectal Exam (DRE)

Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. The PSA test measures the level of PSA in the blood. A doctor or nurse takes a blood sample and the amount of PSA is measured in a laboratory.

It is normal for men to have a low level of PSA in their blood. Higher levels of PSA can indicate either prostate cancer or benign (not cancerous) issues in the prostate. As men age, both prostate cancer and benign prostate conditions become more common. The most frequent benign prostate conditions are prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH), or enlargement of the prostate. There is no evidence that prostatitis or BPH causes cancer, but it is possible for a man to have one or both of these conditions and to develop prostate cancer as well.

The U.S. Food and Drug Administration (FDA) approved the use of the PSA test along with a digital rectal exam (DRE) to help detect prostate cancer. During a DRE, a doctor inserts a gloved finger into the rectum and feels the prostate gland through the rectal wall to check for bumps or abnormal areas. Doctors often use the PSA test and DRE as prostate cancer screening tests; together, these tests can help doctors detect prostate cancer in men who have no symptoms of the disease.

A man’s PSA level and DRE status does not give doctors enough information to distinguish between cancer and benign prostate conditions. However, the doctor will consider the results of these tests when deciding whether to check further for evidence of cancer. Only a biopsy can diagnose prostate cancer. During a biopsy, samples of prostate tissue are removed by a needle and viewed under a microscope.

What are the benefits and risks of screening?

How to address prostate cancer presents a complicated public health problem. The disease is common in men and is a leading cause of cancer death. However, not all prostate cancer is life threatening. There are many cases where a man with prostate cancer lives the duration of his life without symptoms from the disease. Research on distinguishing aggressive, life threatening disease from harmless, indolent tumors is ongoing. Such a breakthrough will provide progress on screening and treatment protocols. In the meantime, it is recommended men should understand the disease and learn the benefits and risks of screening and treatment.

Prostate cancer is the most common cancer among men after skin cancer, and it is the second leading cause of cancer death behind lung cancer. In Arkansas, a man is more likely to die from prostate cancer than a woman is from breast cancer. Each man has a one in seven chance of developing the disease in his lifetime. When detected and treated in early stages of the disease, before symptoms are present, five year survival rates are well over 90 percent. More than 2 million men in the United States count themselves as prostate cancer survivors. Since screening began in the early 1990s, death rates have steadily decreased.

Early detection and treatment are successful interventions for survival outcomes, however many prostate cancers are slow growing and may never become life threatening. Also, treatments like surgery and radiation can have urinary, bowel, and/or sexual side effects that may affect a man’s quality of life.

Because of the need for better understanding between cases of aggressive, life-threatening disease and slow-growing, indolent tumors, whether to recommend screening for prostate cancer among men with no symptoms is a difficult public health issue.

Prostate Cancer Screening has both benefits and risks:

Benefits

If a man has life-threatening prostate cancer, and if screening leads to an early stage diagnosis, the test could save his life.

Testing can provide peace of mind when the results are known.

Risks

Not all prostate cancers are life-threatening. Treatment of these prostate cancers will not extend life. Additionally, diagnosis and treatment can result in harm.

PSA Testing:

Some elevated PSA scores can be attributed to benign factors other than cancer, such as infection, inflammation, sexual activity, and trauma. This is called a false positive test result. Men receiving a false positive based on the PSA can experience anxiety. Additionally, they may be referred for a biopsy.

Men can receive a negative test result when they in fact do have cancer. This is called a false negative test result.

Diagnosis:

Biopsies are a procedure that may result in bleeding, infection, and in rare cases death.

Treatment:

If a biopsy leads to a cancer diagnosis, the disease may be low risk, or clinically insignificant. Treatment of low risk prostate cancer will not extend life. Side effects from treatment (including erectile dysfunction and incontinence) may impact quality of life.

Currently the medical community has no consensus on whether men should be routinely screened for prostate cancer. However, there is one area of agreement—men should have an open and honest discussion on the benefits and risks of screening and make the decision they feel is best for them.

What are the benefits and risks of screening?

APCF offers an education and screening program in communities across the state. The service is designed to promote informed consent regarding prostate cancer screening and allows for timely detection of cancer. The program is free to men who do not have a prostate cancer diagnosis and are between ages 45 and 70.

APCF events are made possible through collaborations with local partners and medical volunteers. Local partners help APCF establish screening events by scheduling facilities, soliciting medical volunteers from the local community (phlebotomists to draw blood for the PSA test, physicians or advance practice nurses to perform DREs), and pre-registering men for screening.

At events, APCF conducts education on informed consent, performs administration of the screening, and provides all medical supplies as well as access to laboratory services through a partnership with Baptist Health (support from other laboratory providers may also be secured where available). After events, APCF processes/analyzes lab reports against National Comprehensive Cancer Control Network guidelines and notifies men by mail their screening results with recommendations on next best steps. For men with suspicious test results, the patent navigator will make direct contact to explain test results, answer questions, and advise urological consult if more investigation is warranted.

Through these collaborations, partner organizations help APCF achieve our mission of promoting awareness, encouraging timely detection, and supporting improved treatment of prostate cancer in Arkansas.

Local partners who are interested in scheduling an education and screening program in their community are encouraged to complete the Service Request Form and review the APCF Guidelines on creating an education and screening event.

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