How do they check for prostate. Comprehensive Guide to Prostate Cancer Screening: Tests, Procedures, and Early Detection
What are the main tests used for prostate cancer screening. How is the PSA test performed and interpreted. When should men start getting regular prostate exams. What happens during a digital rectal exam for the prostate. How do doctors evaluate prostate cancer screening results.
Understanding Prostate Cancer Screening: The Importance of Early Detection
Prostate cancer screening is a crucial aspect of men’s health, especially as they age. Early detection can significantly improve treatment outcomes and overall prognosis. This comprehensive guide will explore the various screening methods, their importance, and what to expect during the process.
The PSA Test: A Cornerstone of Prostate Cancer Screening
The Prostate-Specific Antigen (PSA) test is the primary screening tool for prostate cancer. This simple blood test measures the level of PSA, a protein produced by the prostate gland, in a man’s bloodstream.
How is the PSA test performed?
The PSA test is a straightforward blood test that can be easily added to routine blood work. Results are typically available within a few days, making it a convenient and efficient screening method.
Interpreting PSA Test Results
PSA levels are measured in nanograms per milliliter (ng/mL) of blood. While there’s no definitive “normal” PSA level, doctors generally consider readings above 3 ng/mL as potentially concerning and warranting further investigation.
However, it’s important to note that PSA levels can be influenced by various factors, including:
- Age
- Prostate size
- Previous PSA test results
- Other medical conditions like benign prostatic hyperplasia (BPH) or prostatitis
- Certain medications that may artificially lower PSA levels
- Recent urinary tract infections or procedures
The Digital Rectal Exam (DRE): A Hands-On Approach to Prostate Health
In addition to the PSA test, doctors may recommend a Digital Rectal Exam (DRE) as part of a comprehensive prostate cancer screening.
What happens during a DRE?
During a DRE, the doctor gently inserts a lubricated, gloved finger into the rectum to examine the prostate gland. This allows them to feel for any irregularities in size, shape, or texture that may indicate a problem.
While the DRE may cause some discomfort, it is typically a brief procedure and should not be painful. Many men find that the anticipation of the exam is worse than the actual experience.
When Should Men Start Getting Regular Prostate Exams?
The age at which men should begin prostate cancer screening depends on several factors, including individual risk levels.
General Guidelines for Prostate Cancer Screening
- Men at average risk: Begin discussions about screening at age 45
- Men at higher risk (Black men or those with a family history of prostate or other cancers): Begin discussions about screening at age 40
It’s crucial to have an open dialogue with your healthcare provider about the benefits and potential risks of prostate cancer screening to make an informed decision based on your individual circumstances.
Evaluating Prostate Cancer Screening Results: What Comes Next?
After completing the PSA test and DRE, your doctor will evaluate the results in the context of your overall health profile.
Normal Results
If your prostate isn’t enlarged and your PSA level is within the normal range, your doctor will likely recommend repeating the tests at regular intervals of 1-2 years as part of your routine check-ups.
Abnormal Results
If there are signs of prostate enlargement or irregularity, or if your PSA level is elevated, your doctor may suggest:
- Repeating the tests after a set interval to monitor changes
- Performing additional imaging tests such as ultrasound or MRI
- Conducting a prostate biopsy
- Utilizing newer blood or urine tests to help determine if a biopsy is necessary
It’s important to remember that an enlarged prostate or elevated PSA level doesn’t necessarily indicate cancer. There are many benign conditions that can cause these changes.
Advanced Screening Techniques: Beyond PSA and DRE
As medical technology advances, new screening methods are being developed to improve the accuracy of prostate cancer detection and reduce unnecessary biopsies.
Prostate Health Index (PHI)
The Prostate Health Index is a blood test that combines three different PSA markers to provide a more accurate assessment of prostate cancer risk, particularly for men with PSA levels between 4 and 10 ng/mL.
4Kscore Test
This blood test measures four different prostate-specific kallikrein proteins and combines the results with clinical information to estimate the likelihood of aggressive prostate cancer.
PCA3 Test
The Prostate Cancer Antigen 3 (PCA3) test is a urine-based genetic test that measures the expression of the PCA3 gene, which is often overexpressed in prostate cancer cells.
The Importance of Personalized Screening Plans
Given the complexity of prostate cancer screening and the potential for overdiagnosis and overtreatment, it’s crucial to develop a personalized screening plan with your healthcare provider.
Factors to Consider in Personalized Screening
- Age
- Race and ethnicity
- Family history of prostate cancer
- Overall health status and life expectancy
- Personal preferences and values regarding screening and potential treatment
By taking these factors into account, you and your doctor can make informed decisions about when to start screening, how often to screen, and which screening methods are most appropriate for your individual situation.
Addressing Common Concerns About Prostate Cancer Screening
Many men have concerns or misconceptions about prostate cancer screening that may prevent them from seeking timely evaluations. Let’s address some of these common issues:
Is prostate cancer screening painful?
The PSA test is a simple blood draw, which may cause minor discomfort. The DRE can be uncomfortable but is generally not painful and only lasts a few seconds.
Can prostate cancer screening lead to overdiagnosis?
There is a risk of detecting slow-growing cancers that may never cause symptoms or require treatment. However, modern screening approaches and shared decision-making between patients and doctors help mitigate this risk.
Are there any risks associated with prostate cancer screening?
The screening tests themselves carry minimal risks. However, follow-up procedures like biopsies can have potential complications. It’s important to discuss these risks with your doctor when deciding on a screening plan.
By understanding the importance of prostate cancer screening and working closely with your healthcare provider, you can take proactive steps to protect your health and catch any potential issues early. Remember, early detection is key in successfully treating prostate cancer and maintaining overall prostate health.
What are the Tests for Prostate Cancer?
Last Reviewed: August 26, 2021
Beginning at about age 45 (age 40 if you are Black or have a strong family history of prostate or other cancers), all men should talk to their doctor about screening for prostate cancer. Routine screening starts with a PSA blood test and may include a rectal exam—both are simple and relatively painless.
The PSA Test
Prostate cancer screening starts with a PSA test. This is a blood test, and if your doctor is already drawing blood for other tests, the PSA test order can be added. Results should be back within a few days.
The PSA test measures the level of prostate-specific antigen in your blood. PSA is a protein produced by the prostate, and a small amount is normally released into the bloodstream. When there’s a problem with the prostate, more PSA is released. A rising PSA can be one of the first signs of prostate cancer, though there are other factors that can also cause higher PSA levels.
A PSA level above 3 ng/mL may suggest the need for further testing.
In evaluating the results of your PSA test, your doctor will consider:
- Your age
- Your prostate size
- The results of your previous PSA tests
- Other medical conditions, such as BPH or prostatitis
- Whether you’ve taken any medications that may artificially lower PSA, such as finasteride (Proscar or Propecia) or dutasteride (Avodart)
- A history of infections and procedures involving the urinary tract that can elevate the PSA
The DRE
Your doctor may determine that a digital rectal exam (DRE) is useful in evaluating your prostate health. The prostate is just in front of the rectum. For this test, your doctor will gently insert a lubricated, gloved finger into your rectum to examine the prostate for irregularities in size, shape, and texture.
The test is quite brief, and it might be uncomfortable, but it should not be painful.
Your Test Results
Prostate enlargement and mildly increased PSA levels can be a normal part of the aging process, or they could indicate that prostate cancer has begun to develop. Your doctor will take into account your particular situation—including your age, race, and family cancer history—all of which can influence your likelihood of developing prostate cancer.
Learn more about the risk factors for prostate cancer.
If your prostate isn’t enlarged and your PSA level is within normal range, your doctor will likely suggest repeating the tests at regular intervals of 1-2 years as part of your normal checkups. Talk to your doctor about the best course of a personalized prostate cancer screening plan.
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If your prostate shows signs of enlargement or irregularity, or your PSA level comes back a little high, your doctor may suggest repeating the tests after an interval of time to see if your prostate has changed further or your level is on the rise–an indication of a potential problem.
There are many reasons why a man’s prostate may be enlarged–the presence of cancer is only one. So, even if your doctor finds something unusual, it may not mean that you have prostate cancer. The next steps could include repeating the tests, performing an ultrasound or MRI of your prostate, or a prostate biopsy. There are newer blood and urine tests that can be used to help determine if a biopsy is needed.
Want more information? Download or order a print copy of the Prostate Cancer Patient Guide.
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The 2 tests for prostate cancer you should know about
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Prostate-specific antigen (PSA) test
The PSA test is a blood test that measures prostate-specific antigen, a protein made by the prostate. The normal level of PSA changes as you get older. Higher levels of PSA can be caused by several prostate problems, including cancer. Sometimes people with prostate cancer have PSA levels that are not higher than normal.
The PSA test cannot diagnose cancer. It just indicates that there might be a problem with the prostate.
The cost of PSA testing may or may not be covered by your provincial or territorial health system or your insurance. Learn more about how we’re advocating to expand coverage of the PSA test.
Digital rectal exam (DRE)
A DRE is a physical examination of the prostate through the rectum.
A healthcare provider inserts a gloved finger into the rectum to feel the prostate for lumps or anything else that seems unusual.
Using these tests together is better than using either test alone. PSA testing together with a DRE may help find a dangerous cancer early when it is easier to treat.
Follow-up tests
If a problem is found, more tests will be done to find out whether you have prostate cancer or another health problem. Further tests can include:
- a follow-up PSA test
- a transrectal ultrasound (TRUS) – a test that uses sound waves to make a picture of the rectum and nearby organs, including the prostate
- a biopsy of the prostate – tissue samples of the prostate are looked at under a microscope
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Men need to take care of their prostate health
Urologists draw men’s attention to the fact that after reaching the age of 45, it is necessary to come for a prostate examination at least once a year, which will help diagnose prostate cancer at an early stage and successfully treat it.
In no case should you ignore any unpleasant symptoms in the genital area or when urinating, as they can warn of a serious problem.
Danute SAVICKAYTE
Importance of early diagnosis
Prostate cancer is the most common cancer among men. This disease is diagnosed mainly in men over the age of 50 years. According to Deimantas Šukis, a urologist at Northway Medical Center, in the early stages, when cancer can still be successfully treated, this oncological disease does not show any symptoms, so men over 40 are recommended to have a prostate exam, and those aged 45-50 should do this regularly to detect prostate tumors in time.
During a routine checkup, a blood test is done to determine the level of PSA (prostate specific antigen). Starting from the age of 45-50 years, men are recommended to do this analysis once a year. In addition to a blood test for PSA, the doctor performs palpation of the prostate. If, after a PSA test or palpation, the doctor suspects the presence of possible formations, the doctor takes a sample of prostate tissue for a biopsy, which will confirm or not confirm the diagnosis of a prostate tumor.
If a prostate tumor is detected, the doctor selects the necessary treatment, which, as a rule, is highly effective in the initial stages of the disease.
“Prostate cancer, although often diagnosed, most often develops slowly: from the initial stage of the disease to the spread of metastases to other organs, it can take more than one year. If the disease is diagnosed early, then there will be time for its treatment, – says D. Shukis. “In addition, if cancer cells were detected in a small amount, the patient does not need to be operated on, only actively monitored.”
After prostate surgery, complications such as impaired urination and erectile dysfunction are possible. But, according to the urologist, men should not be afraid of this, because. the complication rate is very low. Most patients return to normal life after 6-12 months.
An alternative (surgical) treatment for prostate cancer is radiation therapy, which is also a radical treatment. The “gold standard” remains surgical intervention, because.
Radiation therapy is used in cases where the patient cannot be operated on for one reason or another.
All tests and tests needed to diagnose prostate cancer are performed at Northway Medical Center. In the center, you can go through a urological examination program, choosing which men can check their health and save money.
Do not ignore the symptoms
According to D. Shukis, men who care about their health should not ignore even the slightest unpleasant symptoms in the pelvic or genital area, i.e. they can indicate not only the presence of prostate cancer, but also any other serious disease.
It is not uncommon for older men to be diagnosed with benign prostatic hyperplasia (prostate). It develops when, with age, due to hormonal changes, the growth of prostate tissue begins, causing a violation of urination. At the initial stage of the disease, the doctor prescribes drug therapy that reduces the symptoms of the disease and stops the growth of the prostate, and later, when drugs no longer help or complications of the disease occur (for example, urinary retention, urolithiasis of the bladder, chronic infection), surgical treatment is used.
Another common disease is chronic inflammation of the prostate. Men of all ages suffer from this unpleasant disease. Its symptoms include pain, discomfort in the lower abdomen, genitals, and impaired urination. As a rule, the cause of chronic inflammation of the prostate is an untreated or improperly treated cold. Chronic inflammation of the prostate is usually treated with antibiotic medicines. Lack of treatment for this disease increases the likelihood of developing prostate cancer, increases the symptoms of benign prostatic hyperplasia. For this reason, men who have urinary problems or pain in the genital or pelvic area are advised to contact a urologist as soon as possible, undergo examination and begin treatment.
How to diagnose male prostatitis – advice from a urologist
How to diagnose prostatitis : Prostatitis in men is a disease of the prostate gland (prostate) that develops as a result of inflammatory changes in it. Primary diagnosis for prostatitis will require an ultrasound of the prostate gland and subsequent consultation with a urologist.
As an additional examination based on the results of the examination, the doctor may prescribe an MRI of the prostate and MSCT of the prostate.
Which doctor treats prostatitis of the prostate gland: Conservative treatment of prostatitis is performed by a urologist or andrologist. Surgical treatment for prostate disease is performed by a urologist surgeon.
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Prostatitis is a disease of the prostate gland, usually associated with inflammation. The condition causes painful or difficult urination, as well as pain in the groin, pelvic region, or genitals. Bacterial infections cause some but not all cases of prostatitis. The prostate gland, about the size of a walnut, is located just below the bladder in men. It surrounds the upper part of the tube that drains urine from the bladder – the urethra. The prostate and other sex glands produce a fluid that carries sperm during ejaculation.
Types of prostatitis
There are generally 4 types of prostatitis:
- acute bacterial prostatitis, a bacterial infection of the prostate, usually with sudden, severe symptoms
- chronic bacterial prostatitis, ongoing or recurrent bacterial infection, usually with less severe symptoms
- chronic prostatitis/chronic pelvic pain syndrome, ongoing or recurring pelvic pain and urinary tract symptoms without signs of infection
- asymptomatic inflammatory prostatitis, signs of prostate inflammation without symptoms.
Symptoms of prostatitis
Symptoms of prostatitis may vary depending on the type of disease. They include:
- pain or burning when urinating
- difficult urination
- frequent urination, especially at night
- frequent need to urinate
- cloudy urine
- blood in urine
- pain in the abdomen, groin or lower back
- pain in the area between the scrotum and rectum
- pain or discomfort in the penis or testicles
- painful ejaculation
- fever, chills, muscle aches and other flu-like symptoms.
Which doctor diagnoses prostatitis
The symptoms associated with prostatitis can be caused by several diseases. It is important to make an accurate diagnosis and start treatment as soon as possible. See an andrologist immediately if you have any of the following:
- difficult urination
- Painful urination with fever
- blood in urine
- severe discomfort or pain in the pelvis or genitals.
Causes of prostatitis
Causes depend on the type of prostatitis.
- Acute bacterial prostatitis is usually caused by common strains of bacteria. Infection may spread from other parts of the urinary or reproductive system
- Chronic bacterial prostatitis usually has the same cause as an acute bacterial infection. It may occur when treatment for an acute infection is not long enough or when all bacteria have not been eradicated
- chronic prostatitis/chronic pelvic pain syndrome is not well understood. Research shows that multiple factors may play a role in the aggregate. These include a previous infection, nervous system dysfunction, immune system dysfunction, psychological stress, or irregular hormonal activity
- Asymptomatic inflammatory prostatitis of unknown cause, usually found only on examination for other conditions and not treated
Risk factors
Risk factors for prostatitis include:
- mean age
- previous prostatitis
- infection of the urinary or reproductive system
- HIV infection or AIDS
- use of urinary catheter
- diagnostic sampling of prostate tissue.
Additional risk factors for chronic prostatitis/chronic pelvic pain syndrome may include:
- psychological stress
- Pelvic nerve injury due to surgery or trauma.
Complications
Complications of acute or chronic prostatitis include:
- bacteremia
- epididymitis
- prostatic abscess
- infection spreading to the upper part of the pelvic bone or the lower part of the spine.
Complications of chronic prostatitis/chronic pelvic pain syndrome may include:
- anxiety or depression
- erectile dysfunction
- changes in semen and spermatozoa that can lead to infertility.
There is no direct evidence that prostatitis can lead to prostate cancer. Researchers are investigating whether chronic inflammation of the prostate is a risk factor for cancer.
Diagnosis of prostatitis
The symptoms associated with prostatitis can be caused by a number of diseases.
The patient may be referred to a urologist. An andrologist will perform a physical exam, review symptoms and medical history, and order tests to determine the cause and rule out certain conditions. Research for the diagnosis of bacterial infections. Diagnostic examination to assess the presence of infection includes:
- digital rectal examination. In this procedure, the doctor inserts a lubricated gloved finger into the rectum to look for inflammation of the prostate gland
- urinalysis. A urine sample is required to be analyzed for the presence and type of bacterial infection
- blood test. Blood samples may be tested for signs of infection and other prostate problems
- prostate sample analysis.
Other tests
If initial tests show no signs of infection, your doctor may order other tests, including:
Urodynamic testing. Various tests can be used to measure how well the bladder and urethra hold and release urine. These methods help determine the nature of urinary problems and identify the source of problems
visualization.
Imaging studies of a prostate ultrasound or MRI of the prostate may be ordered to check for abnormalities in the prostate, abnormal masses, or other problems in the pelvic area that may contribute to pain.
Treatment
The treatment of prostatitis is aimed at eliminating inflammation and pain. At the moment, there is no universal therapy that suits all men. The development of a treatment plan is always built individually and depends on the characteristics of the patient’s disease. Among the most popular methods of drug therapy are:
- Silodosin
- 5-alpha reductase inhibitors
- non-steroidal anti-inflammatory drugs
- glucosamine
- chondroitin sulfate
- muscle relaxants
- neuromodulators.
Alternative treatments include:
- warm baths
- local heating
- therapeutic exercise: kegel exercises to work the muscles of the pelvic floor, and myofascial release to stimulate the muscles of the pelvis, lower back and legs
- muscle relaxation exercise
- phytotherapy with herbal extracts: quercetin, bee pollen and saw palmetto extract
- acupuncture.
Medical and alternative treatments are used under strict medical advice. Only a urologist will be able to choose the optimal combination of therapeutic methods, eliminating the risk of side effects.
Author: Sushkov Slava Andreevich
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, Vnnarov A.Z., Akhvlediann N.D. Chronic prostatitis and sexual disorders // Abstracts of the Plenum of the Board of the Russian Society of Urologists. – Saratov. 2004. P-169-177.Latest articles about diagnostics
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