When Should You Start Having Annual Prostate Exams?

Early cancer detection can save lives and cut treatment costs. But when should you start having prostate exams — and do you need to have them at all?

When it comes to screening for prostate cancer, some men may be confused or apprehensive about beginning to get annual exams.

As prostate cancer affects one out of every eight men, the American Cancer Society and other leading medical organizations recommend older men discuss having annual prostate cancer screenings with their primary care doctor to help detect the disease early. Early detection of the disease helps cure it in 90% of cases.

Generally, it is recommended that men with an average risk of prostate cancer start being screened with a digital rectal exam and prostate-specific antigen (PSA) blood-level exam, when they hit the age of 50. African American men and men who have a father, brother or son who were diagnosed with prostate cancer when they were younger than 65 are at higher risk and should start screenings at age 45. Men who have had more than one of these close relatives diagnosed before age 65 are at even higher risk.

Prostate cancer begins when cells in the prostate gland, which is only found in men, start to grow uncontrollably. Located below the bladder and in front of the rectum, the prostate makes a fluid that is part of semen.

The size of the prostate changes with age: It’s the size of a walnut in younger men, while it’s larger in older men. Other than skin cancer, prostate cancer is the most common cancer in American men. According to the American Cancer Society, this year about 288,300 new cases of prostate cancer will be diagnosed, and 34,700 men will die from the disease.

Two main screening tests

There are two tests commonly used to screen for prostate cancer:

• Digital rectal exam (DRE): A doctor or nurse inserts a gloved, lubricated finger into the rectum to estimate the size of the prostate and feel for lumps or other abnormalities.
• Prostate-specific antigen (PSA) test: This exam measures the level of PSA (a substance made by the prostate) in the blood. The levels of PSA in the blood are often higher in men who have prostate cancer. The PSA level may also be high in other conditions that affect the prostate. Usually, the higher the blood’s PSA level is, the more likely it is that a prostate problem is present. But other factors, such as age and race, also can raise PSA levels. PSA levels also can be impacted by certain medical procedures, some medications, an enlarged prostate or a prostate infection. Since your PSA level may be high for other reasons, your doctor will need to interpret the test results.

If the results of the PSA and/or DRE suggest that you might have prostate cancer, your doctor will need to do a prostate biopsy to find out. This means a sample of your prostate tissue will be removed with a needle and sent to a lab, where a specialist will determine if it contains cancer cells.

Weighing your options for treatment

If you test positive for prostate cancer, you have some options as to what you’d like to do about it. Until recently, nearly everyone opted for surgery or radiation. Some patients choose not to undergo treatment, instead opting for active surveillance, during which the cancers are left alone but regularly monitored to be certain that they’re not growing.

“Certainly, screening can lead to earlier prostate cancer detection, and with earlier detection, you’re eligible for multiple different treatments or active surveillance,” says Sia Daneshmand, MD, director of clinical research at USC Urology of Keck Medicine of USC and professor of urology at the Keck School of Medicine of USC. “So, we encourage patients who are candidates for screening to discuss it with their urologist and/or primary care physician so that we can determine what’s the best course of treatment for them.”

There also is a new option for those seeking prostate cancer treatment. It’s called high-intensity focused ultrasound (HIFU), which uses ultrasound beams to non-surgically destroy prostate tumors.

“The goal of focal HIFU is to target and destroy only the significant cancer lesion, thereby preserving the delicate nerves around the prostate, thus protecting both continence and potency,” says Inderbir Gill, MD, founding executive director of USC Urology of Keck Medicine and chair and Distinguished Professor of Urology at the Keck School. “This is a non-invasive, non-surgical, outpatient procedure that does not involve any radiation. There is no blood loss; the recovery is quick; and, typically, the patient is back on his feet and discharged home the same day.”

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