Should I screen for prostate cancer?
Should I screen for prostate cancer?

Screening means checking your body for cancer before you develop any signs or symptoms. Prostate cancer is a slow-growing tumour which may never require treatment in many men. However, in some men, prostate cancer can grow quickly and may spread to other parts of the body. Early detection is crucial in these men to ensure better chance of recovery with timely treatment.

The goal of prostate cancer screening is to search for cancer that may be at high risk of spreading and treat them early. There are two common tests to screen for prostate cancer:

  • Digital rectal examination (DRE): During the examination, the doctor inserts a lubricated, gloved finger into the rectum to feel the surface of the prostate for any irregularities. It is usually followed by a PSA blood test.
  • Prostate Specific Antigen (PSA) blood test: This test measures the amount of PSA (a substance made by the prostate gland) in the blood. Whilst PSA test is useful for detecting early-stage prostate cancer particularly in high-risk men, it also identifies other non-cancerous conditions such as benign prostatic hyperplasia (BPH) and slow-growing tumours that would never threaten a man’s life.

Prostate cancer screening tests, either DRE or PSA, are not fool-proof. They may over or under detect prostate cancer. Your doctor will assess your individual risks and decide with you whether to screen for prostate cancer.

Here are two recommendations from international organisations on prostate cancer screening:

  • The U.S. Preventive Services Task Force (USPSTF) recommends that men between 55 and 69 should discuss the benefits and harms of prostate cancer screening using a PSA test with their doctor before making a decision. Men who are 70 and older should not have routine prostate cancer screening.
  • The National Comprehensive Cancer Network (NCCN) considers a patient’s age, PSA value, DRE results, and other factors in their recommendations.

If you are thinking about being screened, talk to your doctor. Questions that need to be considered are:

  • Do you have a family history of prostate cancer?
  • Do you have other existing medical conditions which make you less likely to undergo prostate cancer treatment and thus benefit from screening?
  • How do you evaluate the potential benefits and harms of screening, diagnosis, and treatment?

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