The earlier that prostate cancer is detected, the easier it is to treat and the greater the chance for a successful treatment. Unfortunately, prostate cancer usually shows no symptoms until it reaches an advanced stage. Early detection generally includes both a prostate specific antigen (PSA) blood test and a digital rectal examination (DRE).
Prostate-specific antigen is a substance that is normally produced by the prostate gland, and a small amount of PSA occurs naturally in the blood. To help ensure an accurate reading, the blood draw for the PSA test must be done prior to the DRE to avoid any stimulation of the prostate gland, which can increase the PSA level. Similarly, ejaculation within 48 hours prior to a man’s blood draw can result in an elevated level of PSA.
The DRE involves a physician inserting a lubricated, gloved finger into the rectum and pressing on the anterior wall of the prostate to feel for abnormalities or nodules. This test is simple, safe, and only takes about 10 seconds to complete, with minimal discomfort. The prostate gland lies in front of the rectum, so only the back wall of the prostate can be checked during a DRE, which enables a physician to feel the size, shape, and texture of the prostate. It’s possible to have prostate cancer without having a palpable ("feelable") tumor, and palpable nodules or abnormalities are not always an indication of prostate cancer.
Without the PSA test, tumors located elsewhere in the prostate gland could go undetected by the DRE. In addition to potentially indicating prostate cancer, an elevated PSA level can be the result of prostatitis (inflammation of the prostate) or benign prostatic hyperplasia (BPH), which is enlargement of the prostate. The PSA test has become controversial because it lacks precision in specifically identifying early prostate cancers, which can result in unnecessary diagnostic tests and treatments, some with potentially significant side effects. However, a PSA test is the first step for detecting prostate cancer at an early stage when the disease can be treated most effectively.
If results from the PSA test and DRE indicate the possibility of prostate cancer, additional testing will be necessary, which may include a biopsy of prostate tissue. If the diagnosis is prostate cancer, invest the time and energy necessary to learn about the disease and understand the specifics of the diagnosis. Empower yourself with the knowledge you will need to take control of managing the disease.
Inconsistent messages in the prostate cancer community about the value of PSA testing have understandably led to confusion. Our concern is that it’s causing some men to forego testing for early detection resulting in physicians seeing an increase in the number of patients with prostate cancer initially diagnosed at an advanced stage.
While no one wants to be over-treated or undertreated, every man has a right to know if he has cancer. We believe that PSA testing is a personal decision and is the responsibility of each man—not each man’s physician. All men should be educated on the pros and cons of PSA testing to determine if and when PSA testing is appropriate for him.