Testing for prostate cancer

Many men are reluctant to undergo prostate checks due to embarrassment or fear of discomfort, but early diagnosis is vital for effective treatment.

At this time, no medical or scientific organisation has issued broad screening guidelines for prostate cancer.

There are, however, two tests often referred to as screening tests for prostate cancer: a digital rectal exam, or DRE, and a prostate specific antigen, or PSA, blood test.

Many men are embarrassed to ask the doctor for a DRE as it involves the doctor inserting a gloved finger into the rectum to feel for abnormalities in the size or shape of the prostate.

The prostate is located in front of the rectum. This test has the limitation that the only area that is examined is the part of the prostate that the doctor can feel.

Many feel that the DRE is an invasion of their body and will not consent to the test. Instead, they prefer the option of the PSA blood test. The prostate specific antigen is a protein which is produced only in the prostate. Although, PSA is mostly found in semen, a small amount is found in the blood. Most healthy men have levels under 4 ng/ml of blood.

However, PSA is not specific to cancer and, therefore, PSA levels can be elevated for reasons other than prostate cancer – including advancing age. Conversely, it can be normal when, in fact, a man has prostate cancer.

There is no question that the PSA test can help to find prostate cancer early; however, it can’t tell how dangerous the cancer is.

The PSA blood test is quick and simple and is not viewed by men as invading their privacy and may detect prostate cancer before symptoms appear and at a stage when the tumour is easily treatable. When PSA tests are done on an annual basis, they are helpful in monitoring the rate of change of a man’s PSA level. Significant increases, especially over a short time, may be indicative of prostate cancer.

On the other hand, PSA testing may detect cancers that will never become clinically significant or cause a health problem for a man, yet will result in him having to undergo potentially risky treatment with potentially severe side-effects.

Although men with an elevated PSA level might not have cancer, after receiving the result of a high PSA level, a doctor is obliged to do additional investigative studies which have risks and financial costs, not to mention the worry it places on a man and his family.

PSA testing can also result in a false sense of security as men with early prostate cancer can have normal PSA results.

The Cayman Islands Cancer Society endorses the recommendations of organisations such as the American Cancer Society and the Canadian Cancer Society that all men aged 50 and older discuss the potential harms and benefits of early detection methods, such as the PSA test, and then make an informed decision as to whether or not to test.

Men who are at higher risk, for example, those with a family history or black men, are encouraged to discuss starting testing at 45, and men considered even higher risk should begin discussions at age 40, for example, those with several close relatives diagnosed with prostate cancer at an early age.

The Cayman Islands Cancer Society also recommends that men have both a DRE as well as a PSA when undergoing prostate testing.

The decision to test for prostate cancer is one for each individual man to make with guidance from his doctor.

For more information on male cancers, the Society or its programmes contact the Cayman Islands Cancer Society by calling 949-7618 or 
emailing [email protected]

Camila Muniz Ferreira is project coordinator of the Cayman Islands Cancer Society.

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