Prostate Cancer

Men who have at least a 10-year life expectancy should undergo annual screening:

• Both the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) should be offered annually, beginning at age 50.
• Men at high risk (African-American men and men with a strong family of one or more first-degree relatives [father, brothers] diagnosed before age 65) should begin testing at age 45.
• Men at even higher risk, due to multiple first-degree relatives affected at an early age, could begin testing at age 40. Depending on the results of this initial test, no further testing might be needed until age 45.

The Prostate-Specific Antigen ( PSA ) Test

This screening test measures the amount of PSA (prostate-specific antigen) in a man’s blood. PSA is a substance made by normal prostate glands. Most men have levels under 4 nanograms per milliliter of blood, but prostate cancer or other factors can cause the level to go up. These factors include having an infection, taking certain drugs and getting older. If your PSA level is over 4, your doctor will usually send you for additional tests to see if the raised PSA level is the result of prostate cancer.

Although the PSA test can help spot cancer, it cannot tell us how dangerous or fast-growing a prostate cancer is. Some prostate cancers grow so slowly, they will not affect a man’s quality of or length of life. For those men who have a slow-growing prostate cancer, treatment with radiation or surgery might not make sense. If you have a higher than normal PSA test, talk to your doctor about your cancer risks and treatment options.

You can find more information about PSA in our Health Library »

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Digital Rectal Exam ( DRE )

In this test, a doctor inserts a gloved, lubricated finger into the rectum to feel for any irregular or firm areas that might be cancer. The prostate gland is next to the rectum, and most cancers begin in the part of the gland that can be reached by a rectal exam. While it is uncomfortable, the exam isn’t painful and takes only a short time. Although the DRE is not generally as effective as the PSA blood test at finding prostate cancer, it can help detect cancers in men with normal PSA levels.

You can find more information about DRE in our Health Library »

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Risk Factors

Several factors can increase a man’s risk of developing prostate cancer. These include:

• Age: A man’s risk of developing prostate cancer rises rapidly after age 50. About two thirds of all prostate cancers are found in men over the age of 65.
• Race: Prostate cancer occurs more often in African-American men than in white American men. Compared with men of other races, African-American men are more likely to be diagnosed at an advanced stage. African-American men are more than twice as likely to die of prostate cancer as white men. Prostate cancer occurs less often in Asian men than in whites. Hispanic men develop prostate cancer at similar rates as white men.
• Nationality: Prostate cancer is most common in North America and northwestern Europe. It is less common in Asia, Africa, Central America, and South America .
• Family History: Having a father or brother with prostate cancer more than doubles a man's risk. If you have several relatives affected with prostate cancer, and they were very young at diagnosis, this can also increase your risk.
• Diet: If you eat a lot of red meat or high-fat dairy products, but eat few fruits and vegetables, this can increase your risk.

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