Prostate cancer screening

Prostate cancer screening is the screening process used to detect undiagnosed prostate cancer in those without signs or symptoms. When abnormal prostate tissue or cancer is found early, it may be easier to treat and cure, but it is unclear if early detection reduces mortality rates. Prostate cancer screening is the screening process used to detect undiagnosed prostate cancer in those without signs or symptoms. When abnormal prostate tissue or cancer is found early, it may be easier to treat and cure, but it is unclear if early detection reduces mortality rates. Screening precedes a diagnosis and subsequent treatment. The digital rectal examination (DRE) is one screening tool during which the prostate is manually assessed through the wall of the rectum. The second screening tool is the measurement of prostate-specific antigen (PSA) in the blood. The evidence remains insufficient to determine whether screening with prostate-specific antigen (PSA) or digital rectal exam (DRE) reduces mortality from prostate cancer. A 2013 Cochrane review concluded PSA screening results in 'no statistically significant difference in prostate cancer-specific mortality...' The American studies were determined to have a high bias. European studies included in this review were of low bias and one reported 'a significant reduction in prostate cancer-specific mortality.' PSA screening with DRE was not assessed in this review. DRE was not assessed separately. Guidelines generally recommend that the decisions whether or not to screen be based on shared decision-making. This involves men being informed of the risks and benefits of screening. The American Society of Clinical Oncology recommends screening be discouraged in those who are expected to live less than ten years, while in those with a life expectancy of greater than ten years a decision should be made by the person in question. In general, they conclude that based on recent research, 'it is uncertain whether the benefits associated with PSA testing for prostate cancer screening are worth the harms associated with screening and subsequent unnecessary treatment.' Prostate biopsies are used to diagnose prostate cancer but are not done on asymptomatic men and therefore are not used for screening. Biopsies are the gold standard in detecting prostate cancer. Infection after prostate biopsy occurs in about 1% while death occurs as a result of biopsy in 0.2%. Prostate biopsy guided by magnetic resonance imaging has improved the diagnostic accuracy of the procedure. Prostate-specific antigen (PSA) is secreted by the epithelial cells of the prostate gland and can be detected in a sample of blood. PSA is present in small quantities in the serum of men with healthy prostates, but is often elevated in the presence of prostate cancer or other prostate disorders. PSA is not a unique indicator of prostate cancer, but may also detect prostatitis or benign prostatic hyperplasia. A 2018 United States Preventive Services Task Force (USPSTF) draft adjusted the prior opposition to PSA screening. It suggests shared decision-making regarding screening in healthy males 55 to 69 years of age. The final recommendation for that age group states screening should only be done in those who wish it. In those 70 and over, screening remains not recommended. Screening with PSA has been associated with a number of harms including over-diagnosis, increased prostate biopsy with associated harms, increased anxiety, and unneeded treatment. On the other hand, up to 25% of men diagnosed in their 70s or even 80s die of prostate cancer, if they have high-grade (i.e., aggressive) prostate cancer. Conversely, some argue against PSA testing for men who are too young, because too many men would have to be screened to find one cancer, and too many men would have treatment for cancer that would not progress. Low-risk prostate cancer does not always require immediate treatment, but may be amenable to active surveillance. A PSA test cannot 'prove' the existence of prostate cancer by itself; varying levels of the antigen can be due to other causes. During a digital rectal examination (DRE), a healthcare provider slides a gloved finger into the rectum and presses on the prostate, to check its size and to check whether any lumps are present. If the examination suggests anomalies, a PSA test is performed. If an elevated PSA level is found, a follow-up test is then performed.