Throw us a bone

by Janet Casperson, BS, MSN, ANP-C

Prostate cancer screening is more controversial than it was just a few years ago.

Prostate cancer is the most common solid tumor and the second most common cause of death related to cancer in men, after lung cancer. 

The American Cancer Society (ACS) reports that over 192,280 new cases were diagnosed in 2009; and approximately 27,360 men will die of this cancer in 2009. The mortality rate has decreased over time and better screening for prostate cancer may be a contributing cause; with early diagnosis leading to earlier treatment being cited as the reason.

Symptoms of Prostate Cancer

There are very few warning signs of prostate cancer:

• May include urinary problems such as a slow stream and pain with urination
• Blood in urine or semen
• Need to urinate frequently, especially at night
• Difficulty starting urination or holding back urine
• Inability to urinate
• Difficulty in having an erection
• Painful ejaculation
• Frequent pain or stiffness in the lower back, hips, or upper thighs

Prostate Cancer Screening Guidelines

The decision to undergo prostate cancer screening is becoming more complicated. The American Cancer Society (ACS) released its updated guidelines for prostate cancer screening in March 2010. These guidelines recommend that, beginning at age 50 (age 45 for African Americans), men should be informed of the risks and potential benefits of being screened for prostate cancer. The ACS further recommends that men without symptoms of prostate cancer and who are not expected to live for more than 10 years (because of age or health) should not be screened for prostate cancer.

Another recommendation is that health care professionals discuss the potential benefits and limitations of screening tests with their patients. The recommended screening test is a prostate-specific antigen (PSA) with or without a digital rectal exam (DRE); with the combination of both improving overall cancer detection. The ACS discourages participation in community screening events for prostate cancer which typically do not offer education about the uncertainties, risks and potential benefits of screening.

These guidelines differ from the American Urology Association (AUA) Guidelines of 2009. The AUA agrees with the new guidelines from the ACS on the value of discussions between the health care provider and the patient being the key to informed consent for prostate cancer testing. Providing as much information about personal risk and benefits is important. However, AUA guidelines state that no PSA age standard applies to all men, and that all men with a life expectancy of ten or more years should have a baseline PSA test at age 40. Guidance from the AUA emphasizes that "The decision to PSA test for early detection of prostate cancer should be individualized."

Prostate Cancer Tests

Prostate cancer screening is most commonly performed with a digital rectal exam (DRE) and blood test of prostate-specific antigen (PSA).

• PSA: Substance produced by the prostate gland in men. It is a marker of prostate cancer and other disorders of the prostate. Non-painful blood test, average cost $100. If your PSA is high for your age range and/or has been rising, more testing may be recommended.
  
  
• DRE: A physical exam with gloved finger placed in rectum to feel prostate gland. This test can detect the presence of hard areas or prostate growths know as nodules (which are highly suggestive of prostate cancer). The DRE also helps with an estimate of prostate size.
  
  
• Prostate biopsy: Procedure where several small bits of the prostate are taken with a needle.
  
  
• Percent-free PSA: Newer and more complex testing for prostate cancer. It is a ratio of the amount of unattached circulating PSA to the total PSA. Men with prostate cancer will have lower values.
  
  
• PSA Velocity: Measurement of how fast the PSA level rises over a length of time. When a PSA is  
• PSA Density: Measurement of PSA in relation to the size of the prostate. The higher the PSA density the more likely prostate cancer is present.

Age-specific PSA ranges:

Early detection followed by early intervention results in fewer deaths from prostate cancer and better outcomes. To help decide if prostate cancer screening is right for you, talk with your health care provider. This will enable you to make an individual, personal, and informed decision about whether you should undergo screening tests.

Factors Affecting PSA Results

• Benign Prostatic Hyperplasia (BPH) can cause PSA to be elevated.
• Prostatitis or inflammation of the prostate can cause PSA to be elevated.
• Prostate biopsy can cause an elevation in PSA.
• Recent sex with ejaculation can cause a mild increase in PSA for a couple of days.
• Digital Rectal Exam (DRE) can cause a mild increase in PSA.
• Bicycle riding may cause a mild increase in PSA.
• Medications such as Avodart and Proscar can decrease the PSA.

References

1. American Cancer Society. American Cancer Society Guideline for the Early Detection of Prostate Cancer: Update 2010. Available at: http://caonline.amcancersoc.org/cgi/content/full/caac.20066v1. Accessed on November 3, 2010.
2. American Urology Association Education and Research, Inc. Prostate Specific Antigen Best Practice Statement: 2009 Update. Available at: www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf. Accessed on November 3, 2010.
3. Best Evidence U. S. Preventive Services Task Force (2008). Screening for prostate cancer: U. S. Preventive Services Task Force recommendations statement. Ann Intern Med. 2008 Aug 5;149(3):185-91.

This article has been reviewed by a member of the Wellness Partners Editorial Board.

Posted November 2010