Prostate Cancer Screening and Risk Factors

Screening for prostate cancer

How is screening done? 

Screening for prostate cancer most commonly includes a digital rectal exam (DRE) and prostate specific antigen (PSA). 

• DRE is an examination of the back side of the prostate (where most cancers grow) with a finger.
• PSA is a protein made by the prostate.  It is obtained by a simple blood test.  Its levels are frequently elevated in cases of prostate cancer.  Your physician will look not only at the level of your PSA, but how it changes over time.  A high PSA or quick increase may indicate a cancer.

Several other tests may be used along with DRE and PSA, to screen for prostate cancer.  These include free PSA (a blood test, different from a regular PSA test) and PCA-3 (a urine test).  These tests can make screening more specific for prostate cancer and can help your physician decide whether to proceed with further evaluation.

When should I get screened? 

There are many recommendations about the age to start screening for prostate cancer, how often to have it done, and at what age to stop screening.  There is, in fact, controversy about the benefit of screening at all.  We recommend yearly screening beginning at age 40 for men at higher risk of developing prostate cancer and at age 50 for men with no other risk factors.  Some organizations which make recommendations for screening are the American Cancer Society, the National Comprehensive Cancer Network, the American Medical Association, and the American Urological Association.  At the very least, you should address the issue of prostate cancer screening with your physician.

Risk Factors for Prostate Cancer

A risk factor is something that increases your chances of getting a disease. It is possible to develop prostate cancer without any of the risk factors listed below.  However, the more risk factors you have, the greater your chance of developing prostate cancer. 

Family History

Family history is the most important risk factor for prostate cancer.  Studies have shown that men with one first degree relative (a father or brother) with prostate cancer have twice the risk of developing prostate cancer.  Men with two or three first degree relatives have five- and eleven- times the risk.  A number of genes have been implicated in prostate cancer, including the BRCA-2 gene which can cause breast and ovarian cancer in women.  Currently, though, there is no routine genetic testing performed in men.

Age

Studies have shown the risk of prostate cancer increases as men age.  After age 50, 30% of men will be diagnosed with prostate cancer. After age 80, this number increases to 60-70%.

Race and Ethnicity

African American men have a 70% higher risk of having prostate cancer. . These men are also more likely to be diagnosed with prostate cancer at higher stages and are more than twice as likely to die of prostate cancer.

 Diet

A diet high in fat – such as red meat and dairy products – has been shown to increase risk of prostate cancer.  Some studies have shown that eating a diet with a high lycopene (an antioxidant found in tomatoes, watermelon, red grapefruit, and asparagus), selenium, and vitamin E, can decrease your risk of prostate cancer.