Early Detection of Prostate Cancer

Introduction to prostate cancer
Risk factors for prostate cancer
Screening for prostate cancer
- Digital rectal examination (DRE)
- Prostate specific antigen test (PSA)
Transrectal ultrasound and needle biopsy

Introduction to prostate cancer

The prostate gland sits below a man's bladder and surrounds the urethra; the secretions of the prostate are a component of semen. Apart from non-melanoma skin cancers, prostate cancer is the most common form of cancer diagnosed in Australian men. It is also the second leading cause of cancer-related death in Australian men. Early detection of prostate cancer can lead to greater treatment options, better patient quality of life and higher remission rates.

Risk factors for prostate cancer

The biggest risk factor for prostate cancer is age. Over 85% of all cases are diagnosed above the age of 60. Most prostate cancers are slow and have an indolent course, and therefore may not alter life expectancy. A family history of prostate cancer is also a risk factor. There is some discussion of certain environmental and lifestyle factors increasing the risk, however no conclusive evidence is available.

In terms of early detection of prostate cancer, there is currently no beneficial evidence for mass screening. The rationale behind this is that many prostate cancers will not actually progress sufficiently to cause a man harm in his lifetime. For this reason, prostate cancer detection should be done on individualised basis, taking into account each man's risk factors. Men above the age of 60, or those with a strong family history may choose to be screened by their general practitioner under this circumstance.

Screening for prostate cancer

Early detection of prostate cancer There are two main forms of screening for prostate cancer. These tests are not 100% accurate and it is important to be aware of this.

Digital rectal examination (DRE)

The first test a doctor may do is a digital rectal exam (DRE). The doctor inserts a gloved finger into the anus and feels the wall of the rectum for any abnormalities in size, shape or texture of the prostate. While these irregularities may not be indicative of cancer, they can give the doctor a general guide of the prostate. It should be noted that some cancers may not be within reach of the finger.

Prostate specific antigen test (PSA)

The next screening test for prostate cancer is the prostate specific antigen test (PSA). PSA is a protein produced by the prostate, and the levels of this protein tend to rise when the prostate enlarges. High PSA levels do not necessarily indicate cancer, as there are other conditions that can cause this (e.g. benign enlargement of the prostate, urinary tract infections). Similarly, a low PSA does not necessarily mean that cancer is not present.

Many organisations, including the Urological Society of Australasia, recommend that all men between the ages of 50 and 70 should have a DRE and/or their PSA tested annually. If there is a strong family history of prostate cancer, testing may start from as early as 40 years old.

Transrectal ultrasound and needle biopsy

If a man's PSA or DRE is abnormal, he may be sent for a transrectal ultrasound (TRUS). This involves a probe being inserted into the rectum to take ultrasound images of the prostate. At the same time, a needle biopsy may be taken to sample prostate tissue for cancer cells – this is generally the most reliable way to confirm the presence of prostate cancer.

The early detection of prostate cancer can be important is some cases, but in others prostate cancer may not affect a man due to its slow growth patterns. If a man is concerned about prostate cancer, it is important for him to consult with his doctor, who can the assess him on an individualised basis.

More information

For more information on prostate cancer, including diagnoses, types of treatments, and some useful tools, videos and animations, see Prostate Cancer.