• home
• find a physician
• patients & visitors
• news & health tips
• after hours care
• map & directions

September Health Tip by Dr. Koller

Prostate cancer is a common cancer in men and is the third most common cause of cancer in men behind lung and skin cancer. The lifetime risk of developing prostate cancer is 17%. However, the risk of dying from prostate cancer is only 3%. Survival from prostate cancer correlates to the extent of the tumor at the time of the diagnosis.

Prostate cancer screening is controversial because there is uncertainty that screening is effective. Typically the blood test called the prostate specific antigen, or PSA, is one modality used in screening for prostate cancer. The other common modality used is the digital rectal exam, or DRE. This is when the physician or other health care provider palpates, or feels the prostate through the rectal wall.

Generally, it is recommend that men, starting at the age of 50, be given informed consent for prostate screening. In those men with a family history of prostate cancer, or in African-American men, it is recommended that this be done between the ages of 40 to 45. African-American men are at higher risk for prostate cancer.

Informed consent means that the health care provider discusses with the patient the pros and cons of prostate cancer screening. PSA and DRE can both have false positive and false negative results. The probability that further invasive testing will be required after screening is high. Aggressive therapy is required to treat a found prostate tumor.

There are a number of benign causes of an elevated PSA. Bacterial prostatitis can elevate the PSA for up to 4-6 weeks. Ejaculation can raise the PSA up to 0.8 ng/ml. DRE can raise it up to 0.4ng/ml. Asymptomatic prostate inflammation, as diagnosed by prostate biopsy, can raise the PSA. Benign prostatic hypertrophy can be associated with gradually increasing PSA's. Increasing age is associated with gradually increasing PSA's.

Prostate cancer screening can be fraught with anxiety which may be exacerbated by screening methods that currently have unproven benefit. However, until we have better methods of early detection of prostate cancer, I recommend PSA and DRE be done. Again, I would start screening at age 50 in the average risk man, but at age 40-45 in the higher risk men as noted above.

For more information:
MU Health Sciences Library