FAQ
Should you be tested for prostate cancer?
Prostate cancer is now the most commonly diagnosed cancer in Canadian men and the second most common cause of death from cancer in men. Many men are concerned and want to learn more about how to protect themselves against this disease.
If you are 50 years or older, you may be wondering if you should be tested for prostate cancer, even if you feel well and have no symptoms. You may have heard about a new test for prostate cancer, called the Prostate Specific Antigen (PSA) test, and are wondering if you should have one. The information that follows will help you make an informed medical decision in conjunction with your doctor. Use this information to help decide what is right for you. Talk to your doctor, discuss what you know about prostate cancer and the tests for prostate cancer, and ask questions that will help you make the best decision.
What is the prostate?
The prostate is a gland, about the size and the shape of a walnut, located just below the bladder. It surrounds the urethra, a tube that carries urine from the bladder through the penis. The prostate produces the fluid that carries sperm. As men grow older the prostate gland increases in size.
What problems does an enlarged prostate cause?
You may experience the following symptoms as your prostate grows in size:
- Urinating very often during the day
- Waking at night to urinate
- Being unable to wait to urinate
- Feeling that the bladder is never empty
- Being slow in starting to urinate
- Straining to urinate
- Stopping and then starting to urinate again
These symptoms are due to prostatism. Prostatism is a condition that blocks the flow of urine from the bladder. The symptoms may or may not be due to cancer, so you should let your doctor know if you have any of the above symptoms.
What is prostate cancer?
Cells in the body usually grow in a controlled manner in the tissues where they belong. Cancer, on the other hand, is an uncontrolled growth of cells that may spread to other parts of the body.
Prostate cancer is an uncontrolled growth of cells in the prostate gland that may in some cases spread to other parts of the body such as lymph glands or bones. The size and extent of the cancer will determine what treatment may be required.
Prostate cancer is the most common type of cancer found in men today. Generally, it affects men over 50 years old.
What are your chances of getting prostate cancer?
We know that as men age the chance of developing prostate cancer increases.
Some men are more likely to get prostate cancer. This include men who:
- are African-American
- have a family history of prostate cancer
- eat a diet high in fat
The Canadian Cancer Society recommends the following healthy lifestyle habits to reduce your chances of getting any kind of cancer, including prostate cancer:
- stop smoking
- eat low-fat, high fibre foods
- exercise regularly
- limit salt, alcohol, and caffeine intake
How is prostate cancer treated?
No two men with prostate cancer are the same. Decisions to treat prostate cancer depend on a man's age and health, how fast the cancer is growing (the grade of the cancer), and the extent of the cancer (stage). Usual treatment choices for cancer that stays in the prostate gland (Stage A and B) are aimed at curing the cancer and include surgery or radiation (X-ray therapy). If the cancer is small and spreads slowly, your doctor may recommend "watchful waiting." That means the doctor will keep a close watch on you and may recommend treatment only if the cancer shows signs of spreading. Treatment may start later if needed.
Treatment for cancer of the prostate that has spread to other parts of the body (Stages C and D) may include radiation, and/or hormonal therapy and is aimed at containing the cancer and minimizing symptoms. Your doctor will help you decide which treatment you need for the type of cancer you have.
Unfortunately, these treatments may have serious side effects including impotence (inability to get or keep an erection) and incontinence (inability to control urine flow). Also, the treatments can cause pain and discomfort.
How is prostate cancer detected?
There are two common methods of detecting prostate cancer. One is a digital rectal examination and the other is the prostate specific antigen (PSA) test.
What is a digital rectal examination (DRE)?
The prostate gland is very close to the rectum. If your doctor does a DRE (a simple examination in which a lubricated gloved finger is passed into the rectum) the prostate can be felt and checked for lumps or changes in size.
A DRE alone cannot tell you if you have prostate cancer. Many cancers are missed by this examination, so if the doctor finds nothing it does not always mean you do not have cancer.
What is a prostate specific antigen (PSA) test?
PSA is a protein produced by the prostate gland and is found in the blood of all men. The PSA blood test measures the amount of this protein in the blood stream.
Some doctors believe men should have a PSA test to find cancer early and treat it before it spreads. Other doctors argue that the PSA test is not an effective screening test because there is no clear proof that having a PSA test improves your chances of being cured of prostate cancer.
Does the PSA test show that you have cancer in your prostate gland?
An elevated PSA tells your doctor there are changes in your prostate. These changes could be caused by a prostate infection, other prostate disease or prostate cancer.
PSA blood test results are not as accurate as we would like them to be. The test will be high in some men who do not have cancer. In fact, 2 out of 3 men who have a high PSA will NOT have prostate cancer. On the other hand, the PSA test will miss some men who DO have prostate cancer, giving them a false sense of security about their health.
To determine if you really do have prostate cancer, following a DRE and PSA test, your doctor may refer you to a urologist. The urologist may want to do a biopsy (a small piece of the prostate gland is taken out and examined under the microscope) to confirm the diagnosis.
Why would you choose to have a PSA test?
- PSA, even with its limitations, is the best available test for detecting prostate cancer.
- PSA can detect cancer of the prostate years before it causes symptoms or can be felt on rectal examination.
- Early treatment may help you live longer.
- You may be relieved if your PSA is normal.
Why would you choose not to have a PSA test?
- To date PSA testing has not reduced death rates from prostate cancer.
- Even if you have a slightly elevated PSA you will need further testing. The tests may cause you anxiety and discomfort.
- High PSA does not always mean you have cancer.
- Low PSA does not always mean you are free of cancer.
If you are thinking of having a PSA test, what questions should you ask yourself - and your doctor?
There are many reasons why men choose to be tested or not to be tested. There are also many uncertainties. Talk to your doctor. You need to understand the facts. Then you can make a decision that is best for you.
- Should I have a PSA test if I have no symptoms?
- Can I have a PSA test if I want it? What does it mean if my PSA level is elevated?
- If I have cancer, what treatment will my doctor recommend? Or, is watching and waiting the best choice for me?
- What are my chances of my cancer being cured?
- What are my chances of having side effects from treatment (such as pain, incontinence or impotence)?
- What effect will knowing my PSA have on me, my life and family?
What does the research show?
Expert opinion is mixed. It may be many years before we can say definitely whether or not screening for prostate cancer improves your chances for recovery.
Remember - when you have questions, ask your doctor.
The above information was provided courtesy of The Alberta Clinical Practice Guidelines Program of the Alberta Medical Association.