Prostate Cancer Screening: When Should You Be Tested?

A high level of prostate-specific antigen (PSA) indicates a greater risk
blue prostate cancer bracelets

For a lot of men, entering middle age used to be fairly straightforward when it came to their health: 1. Eat less, exercise more. 2. Get a colonoscopy. 3. Schedule your first prostate cancer screening.

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Recently, things got a bit muddled when a group of doctors recommended against the popular prostate-specific antigen (PSA) test which screens for prostate cancer.

So what’s a guy who cares about his health to do? If you’re 50 (or 40 and African-American or have a family history of prostate cancer) definitely schedule the test, says Jay Ciezki, MD, from Cleveland Clinic. When you go, expect a blood test that measures the levels of a prostate gland substance called PSA (prostate-specific antigen), as well as a rectal exam. A high level of PSA indicates that a patient is at greater risk for having prostate cancer.

Dr. Ciezki is the lead author on a new study which found that patients benefited from this prostate cancer screening, having better outcomes than patients who did not have screening.

The study, published in the August 2 issue of the journal Urology, compared two groups of prostate cancer patients, one treated in the years before prostate cancer screening was advocated in 1992, the other from 1993-1996.

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Patients treated after 1992 fared better overall, 82 percent surviving 15 years without the cancer metastasizing (or spreading to other parts of the body). Only 74 percent of patients in the earlier group–who had less screening–survived for 10 years without the cancer spreading.

Patients whose prostate cancer does not spread experience a better quality of life and avoid the sometimes painful and costly treatments for later stages of the disease.

Recent research that weighed in against prostate cancer screening, including a Swedish study published in 2011, looked at whether screening made a difference in the death rates among prostate cancer patients—and found that it had no effect. But those studies measured only the likelihood of death from prostate cancer—an uncommon outcome—rather than the more common outcome of the cancer spreading.

Dr. Ciezki says that too much emphasis is placed on treatment in the early stages of prostate cancer and not enough on “active surveillance.”

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At Cleveland Clinic, he explains, “we diagnose the cancer, but then we watch it if appropriate. If it starts to accelerate, then we treat it. If it stays stationary, then we just keep observing it.

“Instead of saying we should or shouldn’t do PSA screening, let’s just come to the realization that the test does detect something,” he adds. “How do we use that information–that’s where the discussions and research should be focused.”

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